U.S. patent application number 12/244697 was filed with the patent office on 2009-05-07 for systems and methods for analyzing persistent homeostatic perturbations.
Invention is credited to Sarka O. Southern.
Application Number | 20090117589 12/244697 |
Document ID | / |
Family ID | 39831267 |
Filed Date | 2009-05-07 |
United States Patent
Application |
20090117589 |
Kind Code |
A1 |
Southern; Sarka O. |
May 7, 2009 |
SYSTEMS AND METHODS FOR ANALYZING PERSISTENT HOMEOSTATIC
PERTURBATIONS
Abstract
This invention is in the field of homeostasis analysis. More
particularly, it relates to systems and methods for analyzing
persistent homeostatic perturbations, i.e. chronic stress, by
measuring levels of biomarkers that are related to chronic stress.
This invention is also directed to systems and methods for
analyzing the molecular mechanisms of chronic stress.
Inventors: |
Southern; Sarka O.; (San
Diego, CA) |
Correspondence
Address: |
DLA PIPER LLP (US)
4365 EXECUTIVE DRIVE, SUITE 1100
SAN DIEGO
CA
92121-2133
US
|
Family ID: |
39831267 |
Appl. No.: |
12/244697 |
Filed: |
October 2, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12282840 |
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PCT/US2008/004448 |
Apr 4, 2008 |
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12244697 |
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60910158 |
Apr 4, 2007 |
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Current U.S.
Class: |
435/7.1 ; 435/15;
435/18; 435/25; 435/27; 435/29; 436/501; 707/999.104; 707/999.107;
707/E17.004 |
Current CPC
Class: |
G01N 2500/10 20130101;
G01N 2800/60 20130101; G01N 2800/00 20130101; G01N 33/6893
20130101 |
Class at
Publication: |
435/7.1 ; 435/29;
435/18; 435/25; 435/27; 435/15; 436/501; 707/104.1;
707/E17.004 |
International
Class: |
G01N 33/53 20060101
G01N033/53; C12Q 1/02 20060101 C12Q001/02; C12Q 1/34 20060101
C12Q001/34; C12Q 1/26 20060101 C12Q001/26; G06F 7/00 20060101
G06F007/00; C12Q 1/30 20060101 C12Q001/30; C12Q 1/48 20060101
C12Q001/48; G01N 33/566 20060101 G01N033/566 |
Claims
1. A method for detecting a stress response in a subject comprising
detecting altered levels of biomarkers in an SR biomarker panel in
a sample from a subject, as compared to a corresponding sample from
a normal subject, wherein the panel comprises at least two
biomarkers, wherein the biomarkers have a variability index above a
threshold value indicating sufficiency to classify samples as
coming from stressed or normal subjects, thereby detecting a stress
response in the subject.
2. The method of claim 1, wherein the subject is an animal, a
plant, a bacterium, a protist, and a fungus.
3. (canceled)
4. The method of claim 2, wherein the animal is selected from the
group consisting of a mammal, a fish, an amphibian, a reptile, a
bird.
5. The method of claim 4, wherein the mammal is selected from the
group consisting of a human, a dolphin, a whale, an elephant, a
dog, a cat, a cow, a sheep, a pig, a horse, a donkey, a mule, and a
goat.
6-9. (canceled)
10. The method of claim 1, wherein the SR biomarker panel comprises
a biomarker from a stress response pathway is selected from the
group consisting of redox, xenobiotics, chaperoning, cell growth,
cell death, cell adhesion, neuroendocrine signaling, immunity,
deoxyribonucleic acid repair, and microbial activation.
11. (canceled)
12. The method of claim 1, wherein the SR biomarker panel comprises
at least one biomarker selected from the group consisting of
.beta.-endorphin, caspase 8, cyclin D1, NADPH-cytochrome P450
reductase, cyclooxygenase 2, cytochrome P450, cytochrome c,
epidermal growth factor receptor, ferritin, glucocorticoid
receptor, glucose regulated protein 58, glucose regulated protein
75, glutathione S-transferase, heat shock protein 25/27, heat shock
protein 40, heat shock protein 60, heat shock protein 70, heat
shock protein 90, heat shock transcription factor-1, heme
oxygenase-1, interleukin 1.beta., interleukin 6, interleukin 8,
interleukin 10, interleukin 12, laminin, leptin receptor,
metallothionein, Mekk-1, Mek-1, inducible nitric oxide synthase II,
c-Fos, c-Jun, serotonin receptor, serotonin, substance P,
superoxide dismutase Mn, superoxide dismutase Cu/Zn, transforming
growth factor .beta., p53, vasoactive intestinal peptide, and
substance P.
13. The method of claim 1, wherein the SR biomarker panel comprises
at least three biomarkers.
14. The method of claim 13, wherein the SR biomarker panel
comprises heat shock factor-1, ferritin, superoxide dismutase
Cu/Zn, Mekk-1, and superoxide dismutase Mn.
15. The method of claim 1, wherein the detection of an altered
stress response is further correlated with i) the presence,
absence, or severity of a particular disease state; or ii) the
likelihood that the subject will contract a particular disease
state.
16. The method of claim 15, wherein the disease state is selected
from the group consisting of toxic chemical poisoning,
radiochemical poisoning, inflammation, brain seizures, cancer,
T-cell leukemia, heart lesions, stroke, neurodegenerative disease,
tissue trauma, immunological deficiency, viral infection,
Alzheimer's disease, vascular dementia, autoimmune disease, gastric
ulcer, chronic pain, oral diseases associated with decreased
salivation, obesity, metabolic syndrome, diabetes, rapid weight
loss, intestinal and blood lipid abnormalities, AIDS, HTLV
infection, skin disorders, cystic fibrosis, nasal allergy,
protozoan infection, fatigue, anemia, alcohol abuse, infectious
diseases, cardiovascular disease, multiple sclerosis, amyotrophic
lateral sclerosis, irritable bowel syndrome, depression, panic
disorders, post-traumatic stress disorder, and reproductive
disorders.
17-24. (canceled)
25. The method of claim 1, further comprising characterizing the
stress response as a medical condition, a biological stress, a
chemical stress, a psycho-social stress, physical stress, or a
combination thereof.
26. The method of claim 25, wherein the medical condition is
selected from the group consisting of cancer, neurodegenerative
diseases, dementia, stroke, tissue injury, brain trauma,
cardiovascular disease, metabolic syndrome, diabetes, periodontal
disease, surgery, autoimmune/inflammatory diseases, lupus
erythematosus, psoriasis, asthma, allergy, infectious diseases,
HIV/AIDS, post-traumatic stress disorder, drug or alcohol addition,
chronic fatigue syndrome, hypertension, and chronic psychological
stress.
27. The method of claim 25, wherein the biological stress is caused
by a stressor selected from the group consisting of a microbial
pathogen, injury, surgery, genetic defect, obesity, starvation,
dehydration, strenuous exercise, fatigue, sleep deprivation and jet
lag.
28. The method of claim 25, wherein the chemical stress is caused
by a stressor selected from the group consisting of hypoxia,
hyperoxia, hyponatremia, ozone, smoke, allergens, alcohol, drugs,
pesticides, herbicides, heavy metals, industrial toxins, biotoxins,
chemical weapons, and a micronutrient deficit.
29. The method of claim 25, wherein the psycho-social stress is
caused by a stressor selected from the group consisting of
psychological trauma, defeat, restraint, isolation, social
disorganization, family separation, parental neglect, new and
conflicting roles and information overload.
30. The method of claim 25, wherein the physical stress is caused
by a stressor selected from the group consisting of heat, cold,
altitude, humidity, mechanical pressure, osmotic pressure, noise,
radioactive materials, electromagnetic radiation and gravity.
31. A method of characterizing a stress response of claim 25,
further comprising conducting a non-biomarker assay.
32. The method of claim 31, wherein the non-biomarker assay is
selected from the group consisting of a health or an environmental
assay.
33. The method of claim 32, wherein the health and environmental
assay is selected from the group consisting of blood pressure,
cholesterol levels, glucose tolerance, hormonal levels, liver
function, infectious agents, genetic test, cognitive
neuropsychological test, psychological stress test, environmental
quality test, and a combination thereof.
34. The method of claim 25, further comprising using the
characterizing to determine a treatment regimen.
35-47. (canceled)
48. A method for screening for an agent that alters a stress
response comprising: (a) contacting a cell with an agent; (b)
detecting the expression level of biomarkers in an SR biomarker
panel in the cell, wherein the panel comprises at least two
biomarkers, wherein the biomarkers have a variability index above a
threshold value indicating sufficiency to classify samples as
coming from stressed or normal subjects; and, (c) comparing the
level of expression of the biomarkers in the SR biomarker panel of
the cell contacted with the agent to the level of expression of the
biomarkers in the SR biomarker panel of a cell that was not
contacted with the agent, wherein the difference in the level of
expression or activity of the biomarker is indicative that the
agent can alter a stress response.
49-50. (canceled)
51. The method of claim 48, wherein the SR biomarker panel
comprises a biomarker from a stress response pathway is selected
from the group consisting of redox, xenobiotics, chaperoning, cell
growth, cell death, cell adhesion, neuroendocrine signaling,
immunity, deoxyribonucleic acid repair, and microbial
activation.
52. (canceled)
53. The method of claim 48, wherein the SR biomarker panel
comprises at least one biomarker selected from the group consisting
of .beta.-endorphin, caspase 8, cyclin D1, NADPH-cytochrome P450
reductase, cyclooxygenase 2, cytochrome P450, cytochrome c,
epidermal growth factor receptor, ferritin, glucocorticoid
receptor, glucose regulated protein 58, glucose regulated protein
75, glutathione S-transferase, heat shock protein 25/27, heat shock
protein 40, heat shock protein 60, heat shock protein 70, heat
shock protein 90, heat shock transcription factor-1, heme
oxygenase-1, interleukin 1.beta., interleukin 6, interleukin 8,
interleukin 10, interleukin 12, laminin, leptin receptor,
metallothionein, Mekk-1, Mek-1, inducible nitric oxide synthase II,
c-Fos, c-Jun, serotonin receptor, serotonin, substance P,
superoxide dismutase Mn, superoxide dismutase Cu/Zn, transforming
growth factor .beta., p53, vasoactive intestinal peptide, and
substance P.
54. The method of claim 48, wherein the SR biomarker panel
comprises at least three biomarkers.
55. The method of claim 54, wherein the SR biomarker panel
comprises heat shock factor-1, ferritin, superoxide dismutase
Cu/Zn, Mekk-1, and superoxide dismutase Mn.
56. A method for constructing a biomarker panel for a stress
response in a subject comprising: (a) obtaining sample material
from a stressed subject; (b) detecting the expression of two or
more biomarkers in the stressed subject, (c) comparing the level of
expression of the biomarkers from the stressed subject to the
expression of the biomarker from a normal subject, wherein
biomarkers having a difference in the expression in the stressed
subject as compared to the normal subject are included in an SR
biomarker panel for a stress response.
57-62. (canceled)
63. A kit for detecting or characterizing a stress response in a
subject comprising a sample collection device and two or more
biomarker-binding molecules that each selectively bind to one of
two or more biomarkers, or to a nucleic acid or protein expression
product or a metabolic product of a biomarker, wherein the
biomarkers have a variability index above a threshold value
indicating sufficiency to classify samples as coming from stressed
or normal subjects.
64. The kit of claim 63, wherein the biomarkers are from a stress
response pathway.
65. The kit of claim 64, wherein biomarkers are from a stress
response pathway is selected from the group consisting of redox,
xenobiotics, chaperoning, cell growth, cell death, cell adhesion,
neuroendocrine signaling, immunity, deoxyribonucleic acid repair,
microbial activation and a combination thereof.
66. The kit of claim 63, comprising three or more biomarker-binding
molecules that each selectively bind to one of three or more
biomarkers.
67. The kit of claim 66, wherein at least one of the biomarkers is
selected from the group consisting of .beta.-endorphin, caspase 8,
cyclin D1, NADPH-cytochrome P450 reductase, cyclooxygenase 2,
cytochrome P450, cytochrome C, epidermal growth factor receptor,
ferritin, glucocorticoid receptor, glucose regulated protein 58,
glucose regulated protein 75, glutathione S-transferase, heat shock
protein 25/27, heat shock protein 40, heat shock protein 60, heat
shock protein 70, heat shock protein 90, heat shock transcription
factor-1, heme oxygenase-1, interleukin 1.beta., interleukin 6,
interleukin 8, interleukin 10, interleukin 12, laminin, leptin
receptor, metallothionein, Mekk-1, Mek-1, inducible nitric oxide
synthase II, c-Fos, c-Jun, serotonin receptor, serotonin, substance
P, superoxide dismutase Mn, superoxide dismutase Cu/Zn,
transforming growth factor .beta., p53, vasoactive intestinal
peptide, and substance P.
68. The method of claim 1, wherein the expression levels of the
biomarkers are measured together using pooled antibodies against
the biomarkers to produce a combined SR biomarker score.
69. The method of claim 68, further comprising measuring the
expression levels of each of the biomarkers individually.
70. The method of claim 56, wherein step (c) comprises determining
a variability index for each biomarker, wherein the biomarkers
having the highest variability index are included in the SR
biomarker panel.
71. The method of claim 70, wherein the biomarkers having a
variability index above a threshold value are included in the SR
biomarker panel.
72. A database comprising a multiplicity of SR biomarker profiles,
wherein an SR biomarker profile comprises an expression level of
biomarkers in an SR biomarker panel in a sample from a subject,
wherein the panel comprises at least two biomarkers, wherein the
biomarkers have a variability index above a threshold value
indicating sufficiency to classify samples as coming from stressed
or normal subjects.
73. The database of claim 72, wherein the SR biomarker panel
comprises at least one biomarker selected from the group consisting
of .beta.-endorphin, caspase 8, cyclin D1, NADPH-cytochrome P450
reductase, cyclooxygenase 2, cytochrome P450, cytochrome c,
epidermal growth factor receptor, ferritin, glucocorticoid
receptor, glucose regulated protein 58, glucose regulated protein
75, glutathione S-transferase, heat shock protein 25/27, heat shock
protein 40, heat shock protein 60, heat shock protein 70, heat
shock protein 90, heat shock transcription factor-1, heme
oxygenase-1, interleukin 1.beta., interleukin 6, interleukin 8,
interleukin 10, interleukin 12, laminin, leptin receptor,
metallothionein, Mekk-1, Mek-1, inducible nitric oxide synthase II,
c-Fos, c-Jun, serotonin receptor, serotonin, substance P,
superoxide dismutase Mn, superoxide dismutase Cu/Zn, transforming
growth factor .beta., p53, vasoactive intestinal peptide, and
substance P.
74. The database of claim 72, wherein the multiplicity of SR
biomarker profiles comprise profiles from stressed subjects and
normal subjects.
75. The database of claim 74, wherein the database is used in the
identification of a stress response.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Continuation-in-Part of U.S. patent
application Ser. No. 12/282,840, filed Sep. 12, 2008, which is a 35
USC .sctn. 371 National Stage application of International
Application No. PCT/US2008/004448 filed Apr. 4, 2008, now pending;
which claims the benefit under 35 USC .sctn. 119(e) to U.S.
Application Ser. No. 60/910,158 filed Apr. 4, 2007, now abandoned.
The disclosure of each of the prior applications is considered part
of and is incorporated by reference in the disclosure of this
application.
FIELD OF THE INVENTION
[0002] The present invention relates generally to systems and
methods for analyzing persistent homeostatic perturbations and more
specifically to measuring levels of biomarkers that are related to
chronic stress.
BACKGROUND OF THE INVENTION
[0003] The health of living organisms is maintained through a
self-regulatory process called homeostasis. Limited, short-term
perturbations of homeostasis caused by routine hardships do not
affect health. In contrast, persistent long-term perturbations of
homeostasis, also called "chronic stress," are often associated
with health disorders. Conditions that cause stress are called
"stressors."
[0004] Stress is a systemic condition and can therefore be analyzed
not only in cells that were originally impacted by a stressor, but
can also be analyzed in remote cells, tissues and biofluids. This
is because stress triggers the activation of adaptive stress
responses via a network of stress response (SR) pathways whose
function is the maintenance of homeostasis. This network is large
and involves hundreds of pathways and molecules. Varied groups of
the SR pathways are activated by different stressors, in different
organisms, and in different sample types. However, a small subset
of the SR pathways respond universally to stress. These "universal"
SR pathways are reproducibly activated by most stressors in most
organisms.
[0005] Stress affects people at all ages. In addition to humans,
stress also affects all living organisms (e.g. animals, plants and
microorganisms) as well as entire ecosystems consisting of multiple
different organisms. Stress has been linked to the risk and
severity of health disorders and diseases. Stress also has adverse
effects on reproduction, on the aging process and on longevity.
[0006] Current laboratory tests for stress rely on the measurement
of hormones such as glucocorticoids (e.g. cortisol) and
catecholamines (e.g. norepinephrine) in blood and saliva. (Arch.
Gen. Psychiatry, 61: 394-401 (2004); Blood Pressure, 13: 287-294
(2004); and International Journal of Hygiene and Environmental
Health, 208: 227-230 (2005).) These hormones are not suitable
targets for a general analysis of stress, because they are not
relevant to many types of stressors. Moreover, these individual
stress biomarkers alone cannot discriminate between stress and
responses to short-term hardships, such as school exams or
exercise. Furthermore, these hormone-based stress tests are not
useful to analyze the molecular mechanism of stress because these
two biomarkers are only related to two SR pathways; the limbic
hypothalamic-pituitary-adrenal axis (glucorticoids) and the
sympathetic nervous system (catecholamines.) These two pathways are
not representative of the universal SR pathways associated with
chronic stress brought on by a broad range of different stressors.
Indeed, many types of stressors do not activate these pathways. For
example, these pathways are not activated by toxic chemicals.
Moreover, these two stress tests have very limited applications in
veterinary care, wildlife conservation and ecology, because they
are not suitable for most nonhuman species.
[0007] There is therefore a need for systems and methods that are
useful to analyze persistent homeostatic perturbations (i.e.
chronic stress) caused by diverse types of stressors in many
different types of organisms. There is also a need for methods that
are useful to analyze the molecular mechanism of chronic stress in
order to guide the development of new tools for diagnostics,
prevention and treatment of stress.
SUMMARY OF THE INVENTION
[0008] The present invention provides systems and methods for
analyzing persistent homeostatic perturbations by measuring levels
of biomarkers that are related to chronic stress.
[0009] In one embodiment, the invention is a method of analyzing
persistent homeostatic perturbations in a sample from a given
source suspected of being exposed to a stressor, comprising the
steps of: constructing a panel of at least three stress response
(SR) biomarkers, wherein the stress response biomarkers are
selected for the panel based on their known or suspected
association with at least two SR pathways; measuring the SR
biomarker levels in the sample; and converting the SR biomarker
level measurements into a SR biomarker profile to analyze the
homeostatic perturbations.
[0010] The samples that are useful in the practice of the present
invention can be take any form, such as solid, fluid or gas, and
can come from a variety of different biological or nonbiological
sources such as whole blood, blood serum, blood plasma, saliva,
exhaled breath, urine, cerebrospinal fluid, fluid derived from a
tissue, bone marrow, lavage fluid, cell culture fluid, fluid
derived from an organ, lymphatic fluid, tears, sweat, seminal fluid
and vaginal fluid. The organ-specific tissue may be, for example,
skin, prostate tissue, or breast tissue.
[0011] The persistent homeostatic perturbations analyzed by
performing the method of the present invention may be caused by a
stressor associated with a physical condition, a biological
condition, a psycho-social condition or a chemical agent.
[0012] The stress response (SR) biomarkers that are the targets of
the systems and methods of the present invention may be previously
known to be or suspected of being associated with SR pathways, such
as: .beta.-endorphin, caspase 8, cyclin D1, cyclooxygenase 2,
cytochrome P450, cytoplasmic cytochrome c, epidermal growth factor
receptor, ferritin, glucocorticoid receptor, glucose regulated
protein Grp58, glucose regulated protein Grp75, glutathione
S-transferase .pi., heat shock protein 25/27, heat shock protein
40, heat shock protein 60, heat shock protein 70, heat shock
protein 90, heat shock transcription factor HSF-1, heme
oxygenase-1, interleukin IL-1.beta., interleukin IL-6, interleukin
IL-8, interleukin IL-10, interleukin IL-12, laminin, leptin
receptor, metallothionein, stress-activated MAP kinase Mekk-1,
mitogen-activated MAP kinase Mek-1, NADPH-cytochrome P450
reductase, inducible nitric oxide synthase II, proto-oncogene c-Fos
protein, proto-oncogene c-Jun protein, serotonin receptor,
serotonin, substance P, superoxide dismutase Mn, superoxide
dismutase Cu/Zn, transforming growth factor .beta., tumor
suppressor p53 and vasoactive intestinal peptide.
[0013] Other SR biomarkers are listed in FIG. 3, or can easily be
indentified from a review of the scientific literature.
[0014] A SR biomarker panel may comprise or consist of all of the
aforementioned SR biomarkers listed in FIG. 2, or FIGS. 2 and
3.
[0015] As indicated in FIG. 2, the listed SR biomarkers are known
to be associated with the following SR pathways; redox,
xenobiotics, chaperoning, cell growth, cell death, adhesion,
neuroendocrine signaling, immunity, deoxyribonucleic acid repair
and microbial activation.
[0016] An important aspect of the present invention is the
recognition that chaperoning as a SR pathway is uniquely associated
with numerous different stressors in a variety of samples from a
variety of organisms. Accordingly, constructing a panel of SR
biomarkers known to be associated with chaperoning can provide
useful information about persistent homeostatic perturbations
without including SR biomarkers associated with any other SR
pathways. Thus, in one embodiment, the SR biomarkers in the panel
are selected from: glucose regulated protein GRP58, glucose
regulated protein GRP75, heat shock protein 25/27, shock protein
40, heat shock protein 60, heat shock protein 70, heat shock
protein 90 and interleukin IL-6.
[0017] One representative SR biomarker panel includes at a minimum
the following SR biomarkers: heat shock transcription factor HSF-1,
super oxide dismutase Cu/Zn, stress activated mitogen activated
protein kinase Mekk-1, super oxide dismutase Mn and ferritin.
[0018] In an alternative embodiment, SR biomarkers are selected for
inclusion in the SR biomarker panel that are known to be associated
with redox control, chaperoning or microbial activation.
[0019] The type of assay (i.e., assay format) that is useful in the
practice of the present invention can be based on any assay known
to be useful to measure nucleic acid, protein, peptide or small
molecule biomarkers. For example, when the SR biomarker is a
protein, peptide or a small molecule, the assay can be performed by
conducting immunohistochemical staining, flow cytometry, enzyme
linked immunosorbant assays, or immunoprecipitation assays.
[0020] In one embodiment, the measured levels of SR biomarkers are
converted into a normalized and log-transformed SR biomarker score
for more convenient data processing.
[0021] Another important aspect of the invention is that the SR
biomarker score is useful in constructing a SR biomarker profile
that has characteristics reflective of the type of sample, the
source of the sample and the nature of the stressor. Such SR
biomarker profiles are ideally capable of classifying the sample as
coming from a normal subject or a subject exposed to the
stressor.
[0022] In addition to SR biomarker profiles, the SR biomarker
measurements can be used to construct a SR pathway profile, the
characteristics of which reflect the nature and degree to which
individual SR pathways are activated as a response to certain
stressors.
[0023] The source of the sample may be an organism from a taxonomic
grouping of organisms selected from the group consisting of:
vertebrate animals; invertebrate animals; protists and fungi;
bacteria; and plants.
[0024] In an alternative embodiment, the method of the present
invention is a method for constructing a panel of stress response
(SR) biomarkers for analyzing persistent homeostatic perturbations
in a test sample from a given source suspected of being exposed to
a stressor, comprising the steps of: obtaining reference samples
from the same source, some of which are normal and some of which
have been exposed to the stressor; identifying candidate SR
biomarkers for the panel based on their known or suspected
association with SR pathways; measuring the candidate SR biomarker
levels in the reference samples; and selecting the candidate SR
biomarkers for inclusion in the panel, wherein the panel includes a
sufficient number of the candidate SR biomarkers to differentiate
between the normal samples and the samples exposed to the stressor
to a preselected reliability level.
[0025] The preselected reliability level may be 100%, in which case
the SR panel can distinguish all normal samples from all abnormal
samples (i.e., those from subjects exposed to the stressor), or it
can be less than 100% reliable, such as 90% or 75% reliable. It is
not necessary for the methods of the present invention to provide
for an absolute differentiation between normal and abnormal
samples, since the SR biomarker profiles and SR pathway profiles
provide a pattern of data that is useful in analyzing the stress
response, regardless of the lack of absolute differentiation.
[0026] The SR biomarker panel thus constructed may include the same
biomarkers described above and/or different SR biomarkers known to
be or suspected of being associated with chronic stress.
[0027] Using the SR biomarker panel of 40 preferred biomarkers,
panels with less than all 40, and in some cases as few as 3, can be
constructed and still be quite useful for analyzing persistent
homeostatic perturbations by generating SR biomarker profiles and
or SR pathway profiles therefrom.
[0028] One alternative embodiment of the present invention is to
measure SR biomarker level decreases, rather than increases, as a
way of monitoring stress interventions such as a disease treatment
protocol. Example 9 describes just such a method involving massage
as an intervention for stress, and the results described therein
show how the SR biomarker score decreases as a result of such
intervention.
[0029] Other aspects of the invention are described throughout the
specification. Accordingly, these and other features, aspects, and
advantages of the present invention will become better understood
with reference to the following description, appended claims, and
accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0030] FIG. 1 is a flow chart describing the relationship between
stressors, SR pathways and SR biomarkers.
[0031] FIG. 2 is a table describing a panel of 40 SR biomarkers and
their associations with SR pathways. The pathways referenced in the
Figure are: 1-redox control, 2-cellular detoxification Phase I and
II, 3-chaperoning, 4-DNA repair, 5-cellular adhesion and motility,
6-cell cycle and growth, 7-cell death, 8-neuro-endocrine signaling,
9-immunity, 10-microbial activation. The Figure also shows the
different taxonomic groups of organisms that the SR biomarkers are
expressed in. The taxonomic groups referenced in the Figure are:
1-vertebrate animals, 2-invertebrate animals, 3-protists and fungi,
4-bacteria; 5-plants. (*) Biomarkers expressed in all taxonomic
groups.
[0032] FIG. 3 is a table listing of additional SR biomarkers.
[0033] FIG. 4 depicts a two-tier SR biomarker assay. In FIG. 4a, a
flow chart for detecting and characterizing stress is depicted.
Tier 1 uses combined SR biomarker scores to provide a low
resolution test suitable for a general detection of stress. Tier 2
uses SR biomarker profiles to provide a high resolution test
suitable for classification and characterization of the stress
identified by Tier 1. FIG. 4b depicts the use of the two-tier SR
biomarker assay for screening of a large sample set and selecting
samples with critical stress levels (+) for medical diagnostics and
treatments.
[0034] FIG. 5 is a table listing antibodies specific for 40 SR
biomarkers, along with their optimized concentrations for the use
in individual or combined SR biomarker assays. The antibodies are
useful in the practice of the present invention. Immunological
cross-reactivity of the antibodies is as follows: H, human; W,
whales and dolphins; U, ungulates (cow, goat, sheep, pig, horse);
C, carnivores (cat, dog, seal); P, reptiles (snake, turtle); R,
rodents (rabbit, guinea pig, rat, mouse); M, marsupials (kangaroo);
B, birds (chicken, duck, sparrow); A, amphibians (frog); F, fish;
I, invertebrates (insects, worms, spiders, sea urchins, jelly fish,
lobsters, clams, hydra); L, lower eukaryotes (fungi, protists,
algae, molds). T, bacteria.
[0035] FIG. 6 depicts average SR biomarker scores in reference skin
samples. Category axis, SR biomarkers 1-40 as listed in FIG. 2.
Value axis, the average scores for individual SR biomarkers across
control and stressed samples. The scores were determined using
immunohistochemical staining and are in a log scale, base 3. Score
0 corresponds to a baseline, scores 1, 2 and 3 correspond to
3-fold, 9-fold and 27-fold increases relative to the baseline.
Error bars are standard deviations.
[0036] FIG. 7 depicts SR biomarker panel scores in reference skin
samples. Category axis, reference skin samples from control and
stressed subjects. Value axis, panel scores calculated as the
average across 40 SR biomarker scores. The scores are in a log
scale, base 3. Score 0 corresponds to a baseline, scores 1, 2 and 3
correspond to 3-fold, 9-fold and 27-fold increases relative to the
baseline. Error bars are standard deviations.
[0037] FIG. 8 depicts SR biomarker profiles in reference skin
samples. Hierarchic clustering of the profiles is shown. Similar
profiles are in clusters, and the length of dendrogram branches is
proportional to relatedness between the profiles. In FIG. 8a,
profiles based on the 40 SR biomarker panel are depicted. FIG. 8b
depicts profiles based on a 5 SR biomarker panel. Both SR biomarker
panels distinguished control and stressed samples (clusters A and
B) with 100% reliability.
[0038] FIG. 9 depicts SR pathway profiles in reference samples. The
profiles represent ten SR pathways listed in FIG. 2. Hierarchic
clustering of the profiles is shown. Similar profiles are in
clusters, and the length of dendrogram branches is proportional to
relatedness between the profiles. Small brackets on the right show
SR pathways that have similar profiles indicative of coordinated
regulation. Large brackets on the bottom show that control and
stressed samples are in separate clusters indicating that SR
pathway profiles classified stress with 100% reliability.
[0039] FIG. 10 depicts combined SR biomarker scores in reference
skin samples. Category axis, reference skin samples from 47 control
and 38 stressed subjects. Value axis, scores for 40 combined SR
biomarkers determined using immunohistochemical staining with
pooled antibodies. The scores are in a log scale, base 3. Score 0
corresponds to a baseline, scores 1, 2 and 3 correspond to 3-fold,
9-fold and 27-fold increases relative to the baseline. Error bars
are standard deviations.
[0040] FIG. 11 depicts the expression scores for combined SR
biomarkers in prostate cancer patients. Category axis, five
micro-anatomical areas of the prostate: high grade tumor and PIN
(high malignancy potential), low grade tumor and atrophic glands
(low malignancy potential) and stroma (healthy tissue). Value axis,
scores for combined 41 SR biomarkers or for PSA, a standard
prostate cancer biomarker. The scores are in a log scale, base 3.
Score 0 corresponds to the baseline staining in control samples.
Scores 1, 2 and 3 and correspond to 3-fold, 9-fold and 27-fold
increases relative to the baseline. Error bars are standard
deviations.
DETAILED DESCRIPTION OF THE INVENTION
[0041] The present invention relates to systems and methods for
analyzing persistent homeostatic perturbations, i.e. chronic
stress, by measuring levels of biomarkers that are related to
chronic stress. This invention is also directed to systems and
methods for analyzing the molecular mechanisms of chronic stress,
and to methods for screening potential therapeutic interventions
for their effects on chronic stress.
[0042] Biological responses to stressors involve hundreds of highly
integrated molecular pathways. However, to practically analyze
chronic stress, a small number of "universal pathways" have been
identified that reproducibly respond to most stressors in most
organisms, and in particular, essentially all vertebrates.
Functional activation of these universal pathways by stressors
generates reproducible patterns of data that can be monitored to
analyze the characteristics and effects of chronic stress.
[0043] The methods described herein are referred to as "stress
response profiling" or "SR profiling," because they relate to the
measurement of the levels of multiple SR biomarkers by performing
SR biomarker assays, where the SR biomarkers are associated with
multiple stress response pathways that are reproducibly activated
by chronic stress (i.e., the universal SR pathways.) The results of
such multi-dimensional SR biomarker assays can be used to construct
a "profile" (i.e. a pattern of data, which is also referred to in
the industry as a "signature" or a "fingerprint") that is
characteristic of the type of stress, the organism and/or the
sample type.
[0044] As depicted in FIG. 1, stressors can trigger persistent
perturbations of homeostasis, i.e., they cause chronic stress.
Biological responses to chronic stress (also referred to as
"adaptive stress responses") can be categorized in terms of the SR
pathways they activate, which are further characterized in terms of
the SR biomarkers associated with these pathways. Thus, SR
profiling of either or both the SR pathway activation or the SR
biomarker levels resulting from such activation can be utilized to
provide molecular signatures of biological responses to stressors
that threaten health, such as stressors that cause chronic stress.
Such SR profiling is therefore useful, in part, to predict
increased risk of disease.
[0045] Unless defined otherwise, all technical and scientific terms
used herein have the same meaning as is commonly understood by one
of skill in the art to which this invention belongs.
[0046] As used herein, the term "living organism" or simply
"organism" is to be understood as encompassing all biological forms
that are single cells or multicellular bodies.
[0047] As used herein, the term "homeostasis" is a biological
process that maintains the health of organisms.
[0048] As used herein, the term "persistent homeostatic
perturbation" is to be understood as a homeostatic change that has
an adverse affect on the health of organisms. It is another way of
referring to "chronic stress" or simply "stressed" which should be
understood to mean a persistent perturbation of homeostasis and
encompassing all forms of chronic cellular stress and chronic
physiological stress.
[0049] As used herein, the term "stressor" is to be understood as
all forms of agents or conditions that give rise to stress.
Stressors according to the present invention include agents and
conditions that are in the outer environment of organisms such as
the air temperature as well as agents and conditions that are in
the inner environment of organisms such as a disease.
[0050] As used herein, the term "adaptive stress response" or
simply "stress response" is to be understood as a homeostatic
process that provides a countermeasure to stress.
[0051] As used herein, the term "stress response pathway" is to be
understood as the form of the stress response that has a specific
function in the organism, such as DNA repair. Stress response
pathways are embodied in expressed molecules (i.e., SR
biomarkers.)
[0052] As used herein, the term "universal stress response pathway"
or simply "SR pathway" is to be understood as a form of stress
response to most stressors, in most organisms. Functional
activation of these SR pathways generates reproducible patterns of
expressed molecules.
[0053] As used herein, the term "SR biomarker" is to be understood
as an expressed molecule known to be or suspected of being
associated with activation of a SR pathway.
[0054] As used herein, the term "SR biomarker profile" is a
multi-dimensional pattern of data whose components are at least two
SR biomarker scores for individual SR biomarkers across a SR
biomarker panel.
[0055] As used herein, the term "SR pathway profile" is a
multi-dimensional pattern of data representing at least two SR
pathways. The components are functions of SR biomarker scores
related to the individual SR pathways. The functions yield
one-dimensional data points that provide simple-to-use indices of
activation levels for the individual pathways.
[0056] As used herein, the term "stress response profiling" refers
to constructing either or both SR pathway profiles or SR biomarker
profiles from SR biomarker assays.
[0057] As used herein, the term "SR biomarker panel" is to be
understood as at least two SR biomarkers that as a group provide
enhanced information about stress responses than single SR
biomarkers.
[0058] As used herein, the term "SR biomarker panel score" or
"panel score" is to be understood as a one-dimensional data point
calculated as the average of SR biomarker scores across a SR
biomarker panel.
[0059] As used herein, the term "SR biomarker score" is to be
understood as a normalized and optionally log-transformed
measurement of a SR biomarker.
[0060] As used herein, the term "measurement" of a SR biomarker is
to be understood as a quantitative or qualitative determination of
the SR biomarker's expression level in a sample from an
organism.
[0061] As used herein, the term "individual SR biomarker assay" or
"SR biomarker assay" is to be understood as an assay of individual
SR biomarkers.
[0062] As used herein, the term "combined SR biomarker assay" is to
be understood as an assay that yields measurements representative
of the combined expression levels for a panel of SR biomarkers.
Stressors
[0063] Stress can be caused by a variety of sources of stressful
conditions, i.e. "stressors." These stressors can be agents or
conditions whose nature is physical, chemical, biological and/or
psycho-social. Stressors are present in the external environment,
for example air temperature, and also in the internal environment
of a biological system, for example genetic defects, obesity or
chronic diseases. Most real world stressors are complex mixtures of
agents and conditions. For example, a military combat operation in
a tropical mountain terrain is a complex stressor that might
involve adverse effects of heat, altitude, humidity, noise,
pesticides, drugs against warfare agents drugs, insect bites,
strenuous exercise, sleep deprivation and conditioned fear.
[0064] Some stressors affect all organisms, for example, heat and
radiation, while other stressors affect only one or a few types of
organisms, for example the HIV virus affects only humans and
several primates.
[0065] In humans, representative stressors are shown in Table 1
below:
TABLE-US-00001 TABLE 1 Representative Stressors in Humans Physical
Chemical Biological Psycho-social heat, cold, light (uv, X-ray),
natural and industrial disease-causing psychological radioactivity,
pressure toxic chemicals including microorganisms, trauma,
restraint, out- (osmotic, mechanical), heavy metals, polycyclic
genetic defects, chronic of-control harm, noise, altitude, gravity
and halogenated diseases, injury, defeat, conditioned hydrocarbons,
petroleum, surgery, obesity, fear, over crowding, pesticides,
warfare hypertension, sleep social agents, carbon monoxide,
deprivation, strenuous disorganization, ozon, drugs, alcohol,
exercise. mother-child tobacco smoke, abnormal separation, parental
oxygen concentration neglect. (hypoxia), abnormal salt
concentration (hyponatremia), dehydration, starvation.
Stress Response Pathways
[0066] Even though the biological response to a stressor typically
involves hundreds of molecular processes, a small subset of these
molecular processes are universally activated by essentially all
types of stressors, but to different degrees. Such activation
generates a reproducible pattern that defines the biological
response to the stressor, and can be referred to as a stress
response (SR) pathway profile.
[0067] Preferred universal SR pathways, or simply "SR Pathways" are
listed below in Table 2:
TABLE-US-00002 TABLE 2 SR Pathways Pathway Referred to as:
Abbreviation 1 Free radical scavenging, redox Redox R homeostasis 2
Cellular detoxification Phase I, II; Xenobiotics X xenobiotic
removal. 3 Chaperoning, protein folding Chaperoning C 4 DNA repair
DNA repair B 5 Cellular adhesion Cell adhesion A 6 Regulation of
cellular cycle and Cell growth G growth 7 Regulation of cellular
death, Cell death D apoptosis, necrosis 8 Neuroendocrine signaling
NE signaling N 9 Regulation of innate and specific Immunity I
immunity 10 Microbial activation Microbial M activation
[0068] SR pathway profiles can be based on activation of all ten
pathways listed in Table 2, or they may be based only on SR
pathways 1 to 9 or 1 to 8.
[0069] Although all of the aforementioned SR pathways are well
characterized and described in the literature, the following brief
descriptions are included to facilitate understanding of their
molecular nature:
[0070] Redox control (1). This pathway regulates levels of reactive
oxygen and nitrogen species (superoxide, nitric oxide, carbon
monoxide) through free radical scavenging proteins such as
superoxide dismutases. Free radicals are essential cellular
mediators but when in excess, they cause cellular dysfunction
through damaging lipids, proteins, DNA and membrane integrity.
[0071] Cellular detoxification (2). Cellular detoxification
provides a defense against chemical threats to cellular integrity.
Phase I detoxification is a cytochrome P450 driven process for
metabolizing a wide variety of endogenous metabolites (e.g. fatty
acids, steroids) and foreign substances (drugs, alcohol, pesticides
and hydrocarbons). Phase II is based on the glutathione metabolism
and provides cellular resistance to oxidants, hydrocarbons and
heavy metals.
[0072] Chaperoning (3). Chaperones fold newly synthesized
polypeptides and denatured proteins and for prevent uncontrolled
protein aggregation. Chaperoning involves hundreds of "client"
proteins and therefore has a key role in multiple biological
functions including cellular protection, metabolism, growth, the
development of multicellular organisms and molecular evolution.
Excessive chaperoning facilitates disease by folding "wrong"
clients such as the diphtheria toxin or mutant p53 that are
cytotoxic or cause cancer.
[0073] DNA repair (4). DNA damage is ubiquitous and therefore the
stability of the genome is under a continuous surveillance by
multiple DNA repair mechanisms. DNA lesions are produced during
transcription and replication, and by metabolic and immunity
by-products (e.g. free radicals produced during aerobic respiration
and by immune cells killing bacteria). DNA can be also damaged by
environmental mutagens such as oxidants, heavy metals, radiation
and viruses. The DNA repair pathway regulates multiple stages and
mechanisms of DNA repair, and is closely linked with cell cycle
control and apoptosis.
[0074] Cellular adhesion and motility (5). This pathway monitors
cellular interactions with the extracellular matrix and also
changes in cytoskeletal matrix such as centrioles, kinetosomes and
other microtubule organizing centers. These processes are essential
for cellular survival, growth, metabolism and motility, and also
for the formation of microbial biofilms and microbial-host
interactions.
[0075] Cell growth (6). In multicellular organisms, cell cycle
progression is strongly regulated during the development and
modulated by growth factors (mitogens), disease and environmental
stress. In mature tissues, most cells do not divide. Cycling cells
in tissues are typically somatic stem cells involved in normal
tissue turnover (e.g. the germinal layer of the skin). Cell cycling
is typically arrested in starved cells and in cells with DNA or
mitochondrial damage. Increased cell growth occurs during immune
responses, wound healing and regeneration of tissues damaged by
environmental stress, toxins, disease or infection. Uncontrolled,
excessive cell growth is found in cancer.
[0076] Cell death (7). The programmed cell death (apoptosis)
"recycles" cellular components and prevents the release of toxins
from dying cells, as happens during necrotic cell death. In animal
tissues, apoptosis is increased in areas of tissue remodeling and
wound healing, and during aging. During a disease, apoptosis can be
increased within the diseased tissue (e.g. psoriatic skin lesions)
and/or in remote tissues and biofluids (e.g. HIV Tat protein is a
soluble mediator that triggers apoptosis in uninfected
lymphocytes). Apoptosis can be also triggered by environmental
stressors that cause mitochondrial damage (e.g. oxidative stress
and uv light).
[0077] Neuro-endocrine signaling (8). This pathway is crucial for
regulating physiological homeostasis and behavioral regulation in
animals including simple invertebrates. It involves a large number
of mediators (hormones, neuropeptides, neurotransmitters) and
cellular receptors produced by specialized tissues (glands and
neural tissues), and also locally in peripheral tissues (e.g. skin
and gut). In vertebrates, two signaling mechanisms provide initial
responses to stress: the limbic hypothalamic-pituitary-adrenal
(LHPA) axis that involves glucocorticoids (e.g. Cortisol) and the
sympathetic nervous system activation via catecholamines. However,
chronic stress also activates signaling of pain and anxiety, energy
balance, metabolism, respiration, circulation and reproduction.
Neuro-endocrine and immune signaling are integrated through common
mediators and provide coordinated responses to environmental stress
and disease.
[0078] Immunity (9). Immunity provides a systemic defense against
biological threats to organism's integrity such as injuries, tumors
and disease-causing microorganisms. Innate immunity provides a
nonspecific defense through soluble mediators (e.g. chemokines,
agglutinins) and specialized cells (e.g. macrophages) that
circulate through the organism and inactivate parasitic
microorganisms, engulf apoptotic cell debris and kill infected and
tumor cells. Innate immunity is found in protists, animals and
plants. Vertebrates use innate immunity during the initial phases
of stress response because it takes several days to activate
specific immunity that provides threat-specific antibodies and
lymphoid cells. Immune regulation is mediated through numerous
signaling proteins called cytokines or interleukins. Increased
immunity can be beneficial (e.g. short-term immune activation that
removes a bacterial infection) or harmful (e.g. chronic
inflammation and autoimmunity increase physiological stress through
oxidative stress and apoptosis).
[0079] Microbial activation (10). This pathway monitors the
activation of stress responses in microorganisms (bacteria, fungi,
viruses), and signaling between microorganisms and host cells. The
stress response pathway, that is interaction between a microbe and
another organism, is related to the formation of microbial
biofilms. A microbial biofilm is a community of microbial species
that are associated with a host organism (animal, plant) or host
microenvironment (soil, rock, lake). Microbial biofilms consist of
comensal microflora (symbiotic microbes) and pathogenic microflora
(parasitic microbes). Comensal microbial biofilms are an integral
part of animal and plant bodies and contribute to physiological
homeostasis. In humans, there are 40-50 species of comensal
bacteria and fungi in each person, and about 200 species in human
population. Human pathogenic microorganisms include protozoa (e.g.
malaria), fungi (e.g. thrush), bacteria (e.g. tuberculosis) and
viruses (e.g. chicken pox).
[0080] In animals, microbial biofilms are primarily associated with
the inner and the outer body surfaces (the mucosal epithelium and
the skin). Therefore microbial biofilms are sensitive both to
environmental stressors (e.g. uv light) as well as to
micro-environmental conditions in host tissues and body fluids
(e.g. oxidative stress). Comensal microorganisms might be an
integral part of the host homeostatic network. Stress responses of
the host and its comensal microorganisms have coevolved and are
highly integrated. Microorganisms might serve as sensors and
mitigators during host stress responses. During physiological
stress, increased signaling between microbial biofilms and host
cells promotes protection of the organism through modulating host's
stress responses. For example, signaling by gastrointestinal
microflora modulates levels of proteins with key roles in redox
control, cellular detoxification, chaperoning, cell growth,
apoptosis and immunity such as metallothionein, Hsp25, ferritin,
p53, TGF beta, IL-8 and IL-10. When pathogenic microorganisms
invade animals or plants, their stress responses are elevated,
which in turn increases stress responses in the host (bacterial
heat shock proteins are animal superantigens). Disease-causing
microorganisms also release soluble mediators that trigger cellular
stress and activate multiple stress response pathways in infected
as well as remote host tissues (e.g. HFW Tat protein). Therefore,
microorganisms might serve as distributed, in situ biosensors for
monitoring physical, chemical and biological stressors (deviations
from optimal growth conditions) in host microenvironments (tissues
and biofluids). Microenvironmental stressors relevant to
microorganisms are shown in Table 1.
[0081] Stress responses in resident microorganisms might produce
signals (soluble factors, cell-cell interactions) that cross-talk
with the host (adjacent and remote cells) and thus provide an early
warning system that alerts the host about microenvironmental
stressors and stimulates host stress responses. This microbial
sensing might complement stress sensing through a host's sensory
organs.
[0082] Stressed microorganisms might modify their microenvironment
in order to restore optimal growth conditions. This might benefit
host cells in the microenvironment. For example, microorganisms
exposed to oxidative stress in the host skin might produce soluble
SOD Mn that will reduce the levels of free radicals in the skin and
thus help to restore redox balance in the skin. Since mucosal sites
are known to be highly integrated through mucosal secretions, lymph
and cellular migration, microbial SOD produced in the skin could
potentially contribute to redox control in remote tissues and
biofluids.
[0083] Stress-resistant comensal (or otherwise non-pathogenic)
"superbugs" could be used to improve stress resistance of the host
organism. Host stress resistance could be improved by boosting
existing stress response pathways (e.g. increasing cold resistance)
or by conferring a novel stress resistance that the host did not
posses previously (e.g. providing a novel detoxification mechanisms
for heavy metals). Alternatively, host could be made more sensitive
to preciously sensed stressors (e.g. improved sense of smell for
previously recognized odogens), or obtain sensitivity to a stressor
it could not sense before (e.g. sensing light in other
wavelengths).
Stress Response (SR) Biomarkers
[0084] Activation of SR pathways by stressors results in a pattern
of expressed molecules such as genes, proteins, metabolites and
lipids, referred to herein as "SR biomarkers. Accordingly, each of
these biomarkers is said to be "associated with" one or more SR
pathways. Measuring the levels of these SR biomarkers provides
useful information about the biological effects of stressors.
Preferably, the SR biomarkers are expressed molecules such as
proteins or fragments thereof, so long as the fragment is capable
of being recognized in an SR biomarker assay with the same
sensitivity as the entire protein.
[0085] Preferred SR biomarkers and their known associations with SR
pathways are listed in FIG. 2. Additional SR Biomarkers and some
but not all of their known associations with SR pathways are listed
in FIG. 3.
[0086] .beta.-endorphin is a neuropeptide produced in the brain and
peripheral tissues, including the skin, by enzymatic cleavage of
the proopiomelanocortin (POMC) polypeptide that also encodes
adrenocorticotropic hormone (ACTH) and several
melanocyte-stimulating hormones (MSH). .beta.-endorphin is also
present in bodily fluids including saliva and cerebrospinal fluid.
.beta.-endorphin is involved in neuroendocrine stress responses by
several means. .beta.-endorphin acts as a pain-killer both directly
through opioid receptors, and indirectly via nitric oxide (NO) and
prostaglandins. .beta.-endorphin also binds non-opioid receptors on
leukocytes and invertebrate hemocytes and participates in host
defenses by mediating anti-inflammatory activity, enhancing
Bacterial phagocytosis and increasing T cell growth.
.beta.-endorphin regulates the homeostasis of metabolic energy
through thermoregulation and by stimulating food intake.
.beta.-endorphin controls reproduction by promoting sexual
activity, ovulation and menstrual cycle maintenance. In birds,
.beta.-endorphin regulates pigmentation. .beta.-endorphin affects
neuronal excitability, stimulate memory retrieval, and participate
in resolution of social conflicts. .beta.-endorphin is induced by
UV radiation, inflammatory pain, antigen or mitogen-driven
activation of leukocytes, leptin, estrogens, the caffeic acid
(coffee, tea, rosemary), xenobiotics, strenuous exercise and
acupuncture. Seasonal variations and embryonic development-related
changes in .beta.-endorphin levels were reported in some species.
Stress responses: G, N, I (Table 2). Disease associations: painful
inflammation, brain seizures, breast cancer, T cell leukemia.
Immunological cross reactivity: human, dolphin, ungulates,
carnivores, rodents, reptiles, amphibians, fish, invertebrates,
protozoa. Molecular conservation: vertebrates, invertebrates,
protozoa.
[0087] Caspase 8 is an upstream protease that drives cell death
through several pathways: receptor-mediated (extrinsic) apoptosis,
mitochondrial (intrinsic) apoptosis, and necrosis. Caspase
8-mediated signaling is also involved in antigen-induced activation
of immune cells. Physiological caspase functions are essential for
tissue development, maintenance, remodeling and immunoregulation.
Deregulated caspase signaling results in an uncontrolled cell
growth and deregulated immunity, with the possibility of tissue
lesions, tumorigenesis, excessive lymphocyte loss and immune
hyperactivity. Pathways: D, I (Table 2). Disease associations:
cancer, heart lesions, stroke, neurodegenerative disease, tissue
trauma, compromised immunity, viral infections. Immunological cross
reactivity: human, monkey, ungulates, carnivores, rodents, birds,
amphibians, fish, invertebrates, protozoa. Molecular conservation:
vertebrates, invertebrates, protozoa.
[0088] Caspase 8 is an upstream protease that drives cell death
through several pathways: receptor-mediated (extrinsic) apoptosis,
mitochondrial (intrinsic) apoptosis, and necrosis. Caspase
8-mediated signaling is also involved in antigen-induced activation
of immune cells. Physiological caspase functions are essential for
tissue development, maintenance, remodeling and immunoregulation.
Deregulated caspase signaling results in an uncontrolled cell
growth and deregulated immunity, with the possibility of tissue
lesions, tumorigenesis, excessive lymphocyte loss and immune
hyperactivity. Pathways: D, I (Table 2). Disease associations:
cancer, heart lesions, stroke, neurodegenerative disease, tissue
trauma, compromised immunity, viral infections. Immunological cross
reactivity: human, monkey, ungulates, carnivores, rodents, birds,
amphibians, fish, invertebrates, protozoa. Molecular conservation:
vertebrates, invertebrates, protozoa.
[0089] Cyclin D1 can act via two different mechanisms, as a CDK
kinase activator it regulates cell cycle progression and as a
transcriptional regulator, it modulates the activity of
transcription factors. In the cell cycle progression, cyclin D1 is
critical in the early G1 phase, through binding and activating
kinases CDK, Cdc and p27(Kip). Cyclin D1 levels vary during
embryonic development suggesting a role in ontogenesis. Cyclin D1
is induced by prostaglandins and DNA damaging agents such as
radiation, and is particularly critical for the growth of the
breast, the eye and the brain tissues, and the sleep-waking cycle
regulation. Cyclin excess is related to cancer progression,
insufficiency triggers apoptosis. Pathways: G, D (Table 2). Disease
associations: cancer, Alzheimer's disease, vascular dementia.
Immunological cross reactivity: human, ungulates, carnivores,
rodents, birds, amphibians, fish. Molecular conservation:
vertebrates, invertebrates, protozoa.
[0090] Cyclooxygenase-2 (Cox-2) is an inducible prostaglandin G/H
synthase that catalyzes a key step in the synthesis of biologically
active prostaglandins (PG), the conversion of arachidonic acid into
prostaglandin H2 (PGH2). PGs have important functions in
inflammation, cardiovascular homeostasis, reproduction, early
development, olfactory signaling and sound sensing. A side product
of PG synthesis are reactive oxygen and nitrogen radicals (RONS)
that drive oxidative stress. Cox-2 teams up with the constitutively
expressed Cox-1 to achieve fine modulation of cells and tissues by
prostaglandins and RONS. Cox-2 is encoded by an immediate-early
gene that is rapidly induced and tightly regulated. Cox-2
activation is positively regulated by NO, via NOS-Cox-2
interactions, and involves the JAK-STAT (in the heart), the NF-KB
(in the kidney) or the ERK (the skin) signaling pathways. Negative
regulation of Cox-2 is mediated by glucocorticoids,
mineralocorticoids and angiotensin. Cox-2 is activated during heart
preconditioning by limited ischemia or exercise, and plays a major
role in cardioprotection. During increased salt uptake and/or water
deprivation, Cox-2 is activated in kidneys and plays an important
role in regulating medullary blood flow and renal salt handling.
Cox-2 is constitutively expressed in colon, contributes to mucosal
integrity and defense against acid-mediated injury, and accelerates
ulcer healing. Cox-2 is also constitutively expressed in cerebral
cortex, hippocampus, hypothalamus and the spinal cord. During
ischemia or traumatic brain injury, Cox-2 is induced in neurons,
glia and the leptomeningeal tissue, and contributes to regulating
blood flow, and RONS signaling. In reproductive tissues, Cox-2 is
induced during ovulation, implantation and labor. NO and PGE
signaling via NOS-Cox-2 is auto-amplified (PGE upregulates NO
production), and plays important neuro-immunoregulatory roles.
Overexpression of Cox-2, driven by endotoxins, cytokines,
endorphins and EGFR, is associated with prolonged proliferative
inflammation, neurodegeneration, and cancers of epithelial origin.
Pathways: R, G, D, N, I (Table 2). Disease associations:
neurodegeneration, cognitive deficits after stroke and traumatic
brain injury, cardiovascular diseases, autoimmune diseases, cancer,
oral diseases associated with decreased salivation, gastric ulcer,
chronic pain. Immunological cross reactivity: human, ungulates,
rodents, birds, fish. Molecular conservation: vertebrates,
invertebrates.
[0091] Cytochrome P 450 IIE1 (CYP450) belongs to a broad super
family of microsomal enzymes with a central role in metabolizing
xenobiotics (Phase I detoxification) in all species of animals,
unicellular organisms, bacteria and plants. CYP450 enzymes mediate
monooxygenase activity involved in effects of opioids, and process
long-chain fatty acids into signal transducing mediators such as
steroid hormones and regulators of kidney functions. Cytochrome
P450 enzymes metabolize a wide variety of substrates including
endogenous molecules (e.g. fatty acids, eicosanoids, steroids) and
xenobiotics (e.g. hydrocarbons, pesticides, drugs, alcohol). CYP450
enzymes are expressed in the liver, the skin, the tongue,
gastrointestinal tract, the uterine cervix, the urinary bladder,
exocrine glands and in respiratory and olfactory epithelial
tissues. Expression levels of CYP450 are modulated by a broad range
of natural and engineered xenobiotics. CYP450 activation requires
NADPH-cytochrome P 450 reductase. CYP450 enzymatic activity is
regulated by fasting, obesity, steroid hormones, the growth hormone
and xenobiotics uptake. RONS are the side-product of CYP450
activity and therefore increased CYP450 expression predicts RONS
excess and incipient apoptosis, inflammation, rapid weight loss
through insulin-regulated glucose and fat utilization, and diseases
of the liver and the kidneys. Extensive genetic polymorphism of
CYP450 results in a broad spectrum of individual and inter-ethnic
differences in homeostasis of endogenous substrates, drugs, toxins
and carcinogens. Recently, skin levels of CYP450 were used as a
biomarker for nonlethal assessment of exposures to environmental
contaminants in wild animals including dolphins, whales and birds.
Pathways: R, X, G, D (Table 2). Disease associations: obesity,
diabetes, rapid weight loss, intestinal, liver and blood lipid
abnormalities, chronic toxin exposure, cancer. Immunological cross
reactivity: human, monkey, dolphin, whale, ungulates, carnivores,
rodents, birds, amphibians, fish, invertebrates, cyanobacteria.
Molecular conservation: vertebrates, invertebrates, protozoa,
fungi, cyanobacteria, algae, plants, bacteria, archaebacteria.
[0092] The native isoform of Cytochrome c (cyt c) is integrated
within the intramitochondrial membranes where cyt c mediates
electron transfer during aerobic phosphorylation. In addition, cyt
c has been identified as a mediator of apoptosis (programmed cell
death). Cyt c has several functions in apoptosis. In the early
phases of apoptosis, the native isoform of cyt c undergoes a
conformational change. The new cyt c isoform translocates from
mitochondria into the cytoplasm and plays a role in initiation of
the apoptotic proteolytic cascade by activating caspase-3. Cyt c
translocation triggers the formation of the mitochondrial
apoptosome, which amplifies apoptosis via the mitochondrial
(intrinsic) pathway. Recently, two additional essential functions
of cyt c in apoptosis have been discovered that are carried out via
its interactions with anionic phospholipids, a
mitochondria-specific phospholipid cardiolipin (CL), and plasma
membrane phosphatidylserine (PS). Execution of apoptotic program in
cells is accompanied by a substantial and early mitochondrial
production of reactive oxygen species (ROS). Because antioxidant
enhancements protect cells against apoptosis, ROS production might
play a role in apoptosis. it was suggested that mitochondria
contain a pool of cyt c that interacts with CL and acts as a CL
oxygenase. The oxygenase is activated during apoptosis, utilizes
generated ROS and causes selective oxidation of CL. The oxidized CL
is required for the release of pro-apoptotic factors from
mitochondria into the cytosol. This redox mechanism of cyt c is
realized earlier than its other well-recognized functions in the
formation of apoptosomes and caspase activation. In the cytosol,
released cyt c interacts with another anionic phospholipid, PS, and
catalyzes its oxidation in a similar oxygenase reaction.
Peroxidized PS facilitates its externalization essential for the
recognition and clearance of apoptotic cells by macrophages. Redox
catalysis of plasma membrane PS oxidation constitutes an important
redox-dependent function of cyt c in apoptosis and phagocytosis.
Thus, cyt c acts as an anionic phospholipid specific oxygenase
activated and required for the execution of essential stages of
apoptosis. Cyt c release from mitochondria is triggered during
cellular stress responses induced by oxidative stress, UV
radiation, glucose starvation, lipid metabolism, and a loss of
integrin-mediated cell adhesion. Nearly all animal cells possess
the capacity to undergo apoptosis when stimulated by an appropriate
trigger. Apoptosis is crucial for ontogenesis and tissue
remodeling, and metamorphosis in amphibians and insects. The
existence of apoptosis in single-celled organisms implies a degree
of interaction between individuals, and might play a role in
life-cycle progression, maintenance of `social order` among
metazoan and protozoan cells, and could perform the role of an
`immune` response. To survive within their hosts, parasitic
protozoa and helminths modulate host apoptosis pathways to their
own advantage--preventing apoptosis in host cells that are
inhabited by parasites and promoting apoptosis in host immune cells
programmed to attack them. In addition to roles in apoptotic
regulation, Cyt c release into the cytoplasm also occurs in cells
that are not apoptotic, e.g. during differentiation of some cell
types such as glandular epithelial cells and keratinocytes in
animals. Pathways: G, D, I (Table 2). Disease associations:
neurodegenerative diseases, cancer, AIDS. Immunological cross
reactivity: human, ungulates, rodents, amphibians, invertebrates.
Molecular conservation: vertebrates, invertebrates.
[0093] The epidermal growth factor (EGF) receptor (EGFR), also
known as the protooncogene c-erbB-2, is a central regulator of
epithelial function. EGFR is one of four homologous transmembrane
proteins that mediate the actions of a family of growth factors
including EGF, transforming growth factor (TGF) and the
neuregulins. EGFR is a tyrosine kinase. EGFR isoforms are present
in the cell membrane and in the extracellular matrix (ECM). EGFR is
expressed in many cell types, preferentially in epithelial tissues
including the skin, the airways, the gut and reproductive tissues,
and also in the bone, the heart and the brain. In protozoa, EGFR is
diffusely localized in the cytopharynx and cortical regions. In
association with the mitogen activated kinase (MAP) pathway, EGFR
mediates neuro-endocrine crosstalk triggered by EGF, TGF-P,
estrogens, opioids and integrins. During stress responses, cells
secrete heat shock protein 70 (hsp70) that stimulates EGFR and
mediates immuno-endocrine cross-talk between the toll-like receptor
(TLR) and EGFR signaling systems. Transient, well-regulated
increases in EGFR expression are essential for controlling cellular
turnover, growth, migration and adhesion during development, tissue
remodeling and renewal, and wound repair. In the brain, EGFR
signaling modulates feeding behavior. In the bone and the heart,
EGFR regulates developmental changes. Ligand-independent activation
of EGFR-MAP signaling triggers mucin release in the airway
epithelium. In addition, EGFR expression is upregulated during
intense physiological stress, tissue injury, UV radiation,
mechanical stress (stretching, compression, abrasion), heat stress,
exposures to air-borne zinc particles or ozone, and cancer. Several
parasitic protozoa produce EGF-like peptides that stimulate host
EGFR expression during host-protozoan interactions. EGFR
overexpression has been linked to increased RONS release, formation
of necrotic lesions in the heart and the brain and stimulation of
cancer growth. Decreased EGFR expression is triggered by a loss of
cellular attachment to ECM, and triggers cell death through
apoptosis or anoikis. Pathways: R, G, A, D, N, I (Table 2). Disease
associations: cancer, skin disorders, cystic fibrosis, allergy with
nasal discharge, protozoan infections. Immunological cross
reactivity: human, ungulates, carnivores, amphibians, fish,
rodents, amphibians, invertebrates, protozoa. Molecular
conservation: vertebrates, invertebrates, protozoa.
[0094] Ferritin has a central role in the homeostasis of iron, heme
and oxygen. In humans, iron is obtained first through
breast-feeding, later through a balanced diet. Iron deficiencies
are common in poor communities. Iron is an essential nutrient for
all organisms, however it is toxic to cells. Iron sequestered in
the inner core of ferritin is bioavailable and nontoxic to cells.
The ferritin molecule generally contains 24 subunits and has the
shape of a hollow sphere hosting up to 4500 ferric Fe atoms inside.
Ferritin subunits have different ratios of heavy chain (H) to light
chain (L). H-rich ferritins catalyse the oxidation of iron (II),
while L-rich ferritins promote the nucleation and storage of iron
(II1). Ferritin is present in most organisms. Ferritin has multiple
intracellular locations: the cytosol, mitochondria and the nucleus.
Ferritin's general role is regulation of the cellular growth, and
protection against iron overload and the associated oxidative
stress, damage to DNA and other cellular components. Ferritin also
has tissue-specific functions. In the retina, ferritin protects
against UV damage. In the brain, ferritin modulates oligodendrocyte
maturation and myelinization, and neurochemical regulation of motor
coordination and memory formation. During immunity processes,
ferritin promotes downregulation of excessive inflammation through
limiting RONS production, augmenting IL-10 and inducing
TNFa-mediated apoptosis. Ferritin is overexpressed by parasitic
microorganisms to provide protection against reactive oxygen
species produced by the host immune cells. The expression level of
ferritin is regulated by iron, heme and nitric oxide. Ferritin
expression level is regulated through changes in tissue iron, heme
and nitric oxide. Ferritin can also actively regulate the overall
tissue iron balance. Ferritin is inducible by the hormones
erythropoietin and progesterone, and by the copper-zinc superoxide
dismutase (a free radical scavenging enzyme). Increased ferritin is
a biomarker for oxidative stress, inflammation, iron overload, W
irradiation stress, and toxic exposures to metals such as manganese
and zinc. Pathways: R, G, D, N, I (Table 2). Disease associations:
fatigue, anemia, alcohol abuse, fever, infectious diseases,
diabetes, cardiovascular diseases, multiple sclerosis, amyotrophic
lateral sclerosis, neurodegenerative diseases, neuroAIDS, cancer.
Immunological cross reactivity: human, dolphin, ungulates,
carnivores, rodents, birds, fish, invertebrates. Molecular
conservation: vertebrates, invertebrates, protozoa, fungi,
cyanobacteria, algae, plants, bacteria, archaebacteria.
[0095] Glucocorticoid receptor (GR) is the preferential transducer
of the glucocorticoid (GC) signaling network. GCs are the primary
circulating vertebrate stress hormones. GCs play an essential role
in the response to environmental stressors, serving initially to
mobilize bodily responses to a challenge and ultimately serving to
restrain neuroendocrine and immune reactions. GCs also mediate a
crosstalk between central and peripheral responses to environmental
stress. GCs are induced via the corticotrophin-releasing hormone
and the hypothalamic-pituitary adrenal axis (HPA) in the brain, and
also through the redox-sensitive transcription in peripheral
tissues. GR activates gene transcription via a glucocorticoid
response unit (GRU), a group of glucocorticoid response elements
(DNA sequences) and transcriptional factors (proteins such as AP-I)
that integrate tissue-specific information with GC response.
Tissue-specific GR isoforms complex with multiple chaperones
thereby increasing the potential for diverse GR signaling. Thyroid
hormone and GCs act through structurally similar receptors, and
interactions at the transcriptional level could lead to regulation
of common pathways. GR mediates cellular redox responses and
CYP450-mediated metabolism of xenobiotics. GR is also involved in
regulation of the cellular growth and differentiation. Increased GR
signaling can inhibit testicular testosterone synthesis and
downregulate reproductive physiology. During immune responses, GR
signaling promotes immunosuppression via cytokine modulation and T
cell apoptosis. In the brain, GR regulates the early development of
neural functions, memory formation and mood control. In fish, GR
mediates homing driven by olfactory signals. Seasonal and
habitat-related variations in GC levels may be one way that animals
control the timing of reproduction and metamorphosis. GR levels
increase during acute stress, chronic stress, and aging. GR levels
transiently decrease during habituation to repeated stress. The
pattern of GR-mediated signaling can be altered proactively by
fetal or infant exposure to glucocorticoids through chronic
maternal stress or infant trauma. This early imprinting of the GR
signaling network results in permanent alterations in
cardiovascular, endocrine, metabolic and neural development, and
life-long individual differences in stress responsiveness. A number
of diseases including autoimmune, infectious and inflammatory
disorders as well as certain neuropsychiatric disorders such as
major depression have been associated with decreased responsiveness
to glucocorticoids (glucocorticoid resistance), which is believed
to be related in part to impaired GR. Glucocorticoid resistance, in
turn, may contribute to excessive inflammation as well as
hyperactivity of corticotropin releasing hormone and sympathetic
nervous system pathways, which are known to contribute to a variety
of diseases as well as behavioral alterations. Glucocorticoid
resistance may be a result of impaired GR function secondary to
chronic exposure to inflammatory cytokines as may occur during
chronic illness or chronic stress. In animals, variations in GR
levels have been utilized as a biomarker for stress induced by
physical stressors (heat, noise), chemical stressors (aromatic
hydrocarbons) and social-psychological stressors (population
density). Pathways: R, X, G, D, I, N (Table 2). Disease
associations: the metabolic syndrome (hypertension, heart disease,
insulin independent diabetes), irritable bowel syndrome,
depression, panic disorders, post-traumatic stress disorder (PTSD),
neurodegenerative diseases, reproductive disorders. Immunological
cross reactivity: human, ungulates, carnivores, rodents, birds,
amphibians, fish. Molecular conservation: vertebrates.
[0096] Heat shock protein 70 (Hsp70) is a stress-induced protein
with chaperone and cytokine functions. Hsp70 is one of the most
conserved proteins (bacteria, plants, animals). Anti-Hsp70
antibodies cross-react between vertebrates, invertebrates,
protozoa. Cytoplasmic hsp40-hsp70-hsp90 proteome is a dominant
chaperone. In animals, cytoplasmic and membrane-bound
Hsp70-hsp40-Bag-4 proteome have anti-apoptotic properties. Soluble
hsp70, produced by monocytes, induces metalloproteinase (MMP9) and
has immunoregulatory properties. Soluble hsp70 was found in human
saliva and blood and might be produced by multiple cell types,
including microbial cells. Soluble Hsp70 in blood binds to, and is
elevated by artificial surfaces (PVC, silicone), thus modulating
hemo-compatibility of the materials. Hsp 70 overexpressed on the
surface of cancer cells is targeted by natural killer cells. Hsp70
produced by pathogenic microorganisms is a major target for humoral
immune response. Primate hsp70 binds to HIV encoded gag proteins
and is encapsulated into HIV virions. In mammals, liver hsp70 and
hsp25 are induced by acetaminophen (Tylenol.RTM.). In protozoa,
hsp70 controls cytoskeletal organization and cell growth. Bacterial
hsp70 (DNAK) and plant hsp70 are major stress-response proteins.
Hsp70 is associated with the M, C, A, G, and I (Table 2)
pathways.
[0097] Catalase is associated with the R pathway (Table 2). It is
involved in redox control.
[0098] Hypoxia-induced factor 1 (HIF-1) is associated with the R
pathway (Table 2). It is involved in redox control.
[0099] Glutathione peroxidase is associated with the X pathway
(Table 2). It is involved in Phase I of cellular
detoxification.
[0100] Carbonic anhydrase is associated with the R and N pathways
(Table 2). It is involved in pH control, redox balance, and brain
function.
[0101] Ornithine decarboxylase is associated with the R pathway
(Table 2). It is activated by blood-brain-barrier (BBB) damage; and
is involved in the synthesis of polyamines, and production of
reactive oxygen species (ROS). It is associated with neurotoxicity
via increased stimulation of glutamate NMDA receptors.
[0102] Vasoendothelial growth factor (VEGF) is associated with the
R and G pathways (Table 2). It is involved in cardiovascular repair
and induced by hypoxia.
[0103] Erythropoietin is associated with the R, A, and G pathways
(Table 2). It is a growth factor and induces MMP and redox proteins
via NF-KB regulated gene transcription.
[0104] Melatonin is associated with the R, A, and G pathways (Table
2). It is a growth factor and regulates circadian rhythms.
[0105] Thyroid-stimulating hormone receptor (TSHR) is associated
with the G pathway (Table 2). It is a growth factor.
Hyperthyroidism correlates with cardiovascular disease.
[0106] Methenyltetrahydrofolate reductase (MTHFR) is associated
with the G pathway (Table 2). It converts homocysteine (Hcy) into
methionine, and dUMP into dTMP in support of DNA synthesis. It is
associated with cardiovascular disorders.
[0107] Nucleostemin is associated with the G and A pathways (Table
2). It is a nucleolar protein linked to p53; is a marker for
somatic germinal cells multiplied and or mobilized by stress; and
controls the balance between proliferation and apoptosis. It is
overexpressed in cancer.
[0108] OCT-4 is a marker for embryonic and somatic germinal
cells.
[0109] .alpha.-Amylase is associated with the N pathway (Table 2).
It is related to stress-induced adrenergic activity (sympathetic
nerves, catecholamines, epinephrine, norepinephrine) and
complements the LHPA axis-driven stress response
(corticotrophin-release hormone, glucocorticoids).
[0110] Norepinephrine is associated with the N pathway (Table 2).
It is related to stress-induced adrenergic activity (sympathetic
nerves, catecholamines).
[0111] Epinephrine is associated with the N pathway (Table 2). It
is related to stress-induced adrenergic activity (sympathetic
nerves, catecholamines).
[0112] Oxytocin is associated with the N pathway (Table 2). It is
related to stress response regulation and lactation.
[0113] Thromboxane synthase (TBXAS 1) is associated with the X, G,
and I pathways (Table 2) It is a CYP450 enzyme; is activated by
tissue traumaldamage, and converts prostaglandins PGH2 into
thromboxane TXA2, an arachidonic acid metabolite that elicits
platelet coagulation and vascular contraction. It is suppressed by
aspirin.
[0114] C-reactive protein is associated with the I pathway (Table
2). It is a marker of systemic inflammation.
[0115] TNF-.alpha. is associated with the I pathway (Table 2). It
is a pro-inflammatory cytokine.
[0116] Heart fatty acid binding protein (H-FABP) is associated with
the I pathway (Table 2). It is involved in arachidonic acid
metabolism, and is linked to Cox-2, NO, and iNOS. It is involved in
brain lipids transport and integrity and BBB integrity.
[0117] Apolipoproteins B and C (apoB, apoC) are associated with the
X, G. N, and I pathways (Table 2). The apolipoproteins are
associated with lipid metabolism, cholesterol formation, LDL,
insulin, triglycerides; steroids, energy balance; serotonin;
inflammation; lipid peroxidation; CYP450-linked cellular
detoxification Phase I; and amyloid formation.
[0118] Metalloproteinase 9 (MMP-9) is associated with the A and I
pathways (Table 2). It is an enzyme that breaks down and remodels
extracellular matrix (ECM); essential for cell adhesion, migration,
invasion. MMP is induced by soluble Hsp7O and erythropoetin. MMP-9
is increased in cancer, diabetes, inflammatory bowel disease,
cardiovascular diseases.
[0119] Fibronectin (Fn) is associated with the A and I pathways
(Table 2.) Fibronectin is an ECM component, integrin receptor and
bacterial receptor. A soluble form sFn indicates cellular breakdown
and induces cytokine expression. sFn is a biomarker for cancer,
diabetes, inflammatory bowel disease, cardiovascular diseases.
[0120] Collagen is associated with the A pathway (Table 2). It is
an ECM component and integrin receptor.
[0121] The cadherins (E-cadherin and pan-cadherin) are associated
with the A, G, and I pathways (Table 2). They play a key role in
cell adhesion and growth. They are necessary for TGF-.beta.
signaling. Loss of cadherin is a hallmark of tumor progression
fostering cancer cell invasion and metastasis. Soluble cadherin is
a serum biomarker for aggressive prostate cancer diabetes,
inflammatory bowel disease, cardiovascular diseases.
[0122] Cell adhesion molecules (I-CAM, V-CAM, and N-CAM) are
associated with the A, G, and I pathways (Table 2). They are
cell-surface bound on variety of cell types, are an ECM component,
and are growth factor receptors. They are induced by SOD. Soluble
forms are increased in cancer, diabetes, inflammatory bowel
disease, cardiovascular disease.
[0123] E-selectin is associated with the A pathway (Table 2). It is
an ECM component. Its soluble form is increased in cancer,
diabetes, inflammatory bowel disease, cardiovascular disease.
[0124] Junctional adhesion molecule A (JAM-A) is associated with
the A pathway (Table 2) It regulates cell migration and resistance
to shear stress by cooperating with microtubule stabilizing
pathways.
[0125] Monocyte chemotactic protein-1 (MCP-I) is associated with
the A and I pathways (Table 2). It is a chemokine that promotes
monocytes-endothelial adhesion, and is increased in
inflammation.
[0126] Calmodulin (CaM) is associated with the A, G, N, and I
pathways (Table 2). It is a protein that mediates cellular ca2+
signals in response to a wide array of stimuli in higher
eukaryotes; essential for delivery of neuroendocrine factors
(endorphins) from leukocytes to neurons during stress. In plants,
CaM is induced by high salt stress and pathogens.
[0127] Integrins a and P are associated with the A and I pathways
(Table 2). The integrins are a family of cell surface molecules
that bind to ECM via fibronectin or laminin; they are involved in
cellular adhesion, migration, and invasion. A large number of
related integrins exist.
[0128] 8-oxoguanine-DNA glycosylase (OGG1) is associated with the B
pathway (Table 2). Base-excision repair (BER) is a dominant pathway
for oxidative DNA damage repair (nuclear and mitochondrial). OGG1,
MYH (below) and MTH1 (below) act synergistically and team up with
APE, DNA polymerases and DNA ligases. BER enzymes are polymorphic
in humans, hence differences in susceptibility to DNA damage. OGG1
excises 8-OH-G from 8-OH-G:C pairs in DNA; its bacterial functional
homologue is MutM.
[0129] DNA glycosylase MUTYH (MYH) is associated with the B pathway
(Table 2). It is involved in BER. MYH removes adenine incorporated
opposite template 8-OH-G during DNA replication; its bacterial
homologue is MutY.
[0130] DNA glycosylase MTH1 is associated with the B pathway (Table
2). It is involved in BER. MTH hydrolyzes 8-OH-dGTP to 8-OH-dGMP in
dNTP pool, thereby reducing the chance of mis-incorporation of
8-OH-dGTP by DNA polymerases; its bacterial homologue is MutT.
[0131] Apurinic/apyrimidinic endonuclease (APE) is associated with
the B pathway (Table 2). It is involved in BER. APE is also called
redox factor/AP endonuclease.
[0132] MSH-2 protein is associated with the B, G, and D pathways
(Table 2). The mismatch repair pathway (MMR) repairs DNA damage due
to UV; links to proliferation and apoptosis control. It is
dysregulated in cancer. Its bacterial homologue is MutS.
[0133] MLH-1 protein is associated with the B, G, and D pathways.
(Table 2). It is involved in the MMR. Its bacterial homologue is
MutL.
[0134] Senescence-associated .beta.-galactosidase (SA-.beta.-gal)
is associated with the B, G, and D pathways. (Table 2). It is
involved in the induction of normal or premature cellular
senescence due to persistent DNA damage and permanent cell
arrest.
[0135] Protein p21 is associated with the B, G, and D pathways
(Table 2). It is a cyclin-dependent kinase inhibitor; it affects
expression of BER enzymes and apoptosis, and arrests cells in GI.
It is induced by oxidative stress; and is linked to p53.
[0136] 8-hydroxy-deoxyguanosine (8-OH-dG) is associated with the B
pathway (Table 2). It is a product of DNA damage repaired by the
BER and NER pathways. It is elevated in urine and blood cells of
cancer patients and in atherosclerotic plaques.
[0137] 8-hydroxy-guanine (8-OH-G) is associated with the B pathway
(Table 2). It is a product of DNA damage repaired by the BER and
NER pathways. It is elevated in urine and blood cells of cancer
patients and in atherosclerotic plaques.
[0138] Peripheral benzodiazepine receptor (PBR) is associated with
the M, R, G, D, N, and I pathways (Table 2). PBR is stimulated by
benzodiazepines (BZD) during anxiolytic signaling in mammals
(endogenous BZD is in breast milk and other biofluids;
valiumldiazeparn is a synthetic BZD). PBR is expressed on
leukocytes and brain cells and mediates neuro-immuno cross-talk.
PBR is also expressed on the mitochondrial (mt) membrane where it
regulates mitochondrial transmembrane potential, mitochondrial
sensitivity to reactive oxygen species, mitochondria mediated
regulation of cell cycle and apoptosis, neurosteroid synthesis.
Many pathogenic viruses encode PBR ligands that regulate cell cycle
and apoptosis, suggesting the possibility for multi-pathway
microbial/mammalian cross-talk via PBR/TspO receptors and
ligands.
[0139] Toll-like receptors (TLR) are associated with the M and I
pathways (Table 2). TLR are a family of proteins that mediate
signals from a variety of bacterial gut products, giving the host a
panel of microbe-recognizing receptors. TLR and NOD-2 are key
mediators of innate host defense in the intestinal mucosa,
crucially involved in maintaining mucosal as well as comensal
homeostasis. In health, TLR signaling protects the intestinal
epithelial barrier and confers comensal tolerance whereas NOD-2
signaling exerts antimicrobial activity and prevents pathogenic
invasion. In disease, aberrant TLR and/or NOD-2 signaling may
stimulate diverse inflammatory responses leading to acute and
chronic intestinal inflammation, and diseases such as the
inflammatory bowel syndrome (IBS). TLR-dependent transcriptional
activation of inflammatory response genes is regulated through the
glucocorticoid receptor (GR). GR differentiates between different
TLR proteins which enables differential regulation of
pathogenspecific programs of gene expression. TLR on placental
trophoblast cells enable the recognition and response to pathogens
at the maternal-fetal interface, which has a significant impact on
the success of a pregnancy.
[0140] Still other biomarkers are associated with one or both of
the specific stress response (SSR) or the general stress response
(GSR) of microorganisms. The SSR allows microorganisms to cope with
a single acute stress situation by eliminating the stress agent
and/or repairing damage that has already occurred. SSR is induced
by envelope stress, heat, radiation, starvation, DNA-damaging
agents, toxins, pH stress. The GSR is predominantly preventative.
It renders the cells broadly stress-resistant in a way that damage
is avoided rather than has to be repaired. GSR also plays a role in
pathogenicity (virulence factors) and biofilms formation. As
detailed below, some biomarkers associated with either the SSR or
the GSR are also associated with other pathways. As the SSR and GSR
affect the interaction between microorganisms and their hosts, they
are part of the M pathway as described above.
[0141] The TspO protein is associated with the M, C, G, and I
pathways (Table 2). TspO is an oxygen/light sensor during SSR. TspO
is homologous to mammalian PBR, both receptors can be stimulated by
benzodiazepine ligands.
[0142] Protease DegP is associated with the M, C, G, and I pathways
(Table 2). DegP removes misfolded envelope proteins during SSR.
[0143] A number of redox proteins, including superoxide dismutase
Fe (sod), glutathione reductase (gorA), alkylhydroperoxide
reductase (ahg), and ferric uptake regulator (fur) are associated
with the M, C, G, and I pathways. (Table 2). They are involved in
redox balance during SSR. Soluble SOD (and other redox regulators)
was found in the mammalian extracellular matrix and body fluids
(blood and saliva). The origin of soluble SOD has not been
determined. Soluble SOD could be a pool of mammalian plus microbial
enzymes. Through soluble SOD, comensal microorganism could
cross-regulate numerous mammalian processes including cellular
growth, cellular migration, wound healing, microbial infections,
neuroprotection, the birth process, hibernation. SOD status
(expression level) is prominently displayed by many animal species
as a condition-dependent sexual signal (e.g. as the red pigment in
the cock's comb).
[0144] Heat shock proteins (chaperones), including GrpE, DNAK
(hsp70 homologue), DNAJ (hsp40 homologue), GroEL (hsp60 homologue),
GroES, and HTPG (hsp90 homologue) are associated with the M, C, G,
and I pathways. (Table 2). Microbial chaperones function as
proteomes: DNAK-DNAJ-GrpE (gram-negative) and GroES-GroEL
(gram-positive). Microbial hsp stimulate host immune system through
multiple mechanisms. Hsp are recognized by lymphocytes as
superantigens, and might also induce co-stimulatory molecules on
lymphocytes.
[0145] Trehalose synthase (Tre-6P) is associated with the M, C, G,
and I pathways. (Table 2). It is involved in the production of
compatible solutes in SSR. In response to dehydration, high
salinity or cold stress, microorganisms produce "compatible
solutes" (glutamate, proline, glycerol, sucrose, trehalose, and
other similar molecules) that stabilize organized water structure,
which has beneficial effects on membrane integrity and protein
folding and stability. Compatible solutes released by comensal
microorganisms might be beneficial for adjacent host cells.
[0146] The multidrug efflux pump (acfAB) is associated with the M,
C, G, and I pathways (Table 2). It acts as an antibiotic resistance
factor in SSR.
[0147] Sigma-S factor (RpoS) and Sigma-B factor are associated with
the M, C, G, and I pathways (Table 2). Sigma-S and B factors are
master regulators of multiple stationary-phase and stress
resistance genes during GSR.
[0148] DNA-binding protein of stationary phase (dps) is associated
with the M, C, G, and I pathways (Table 2). Dps is regulated by
Rpos and controls cell growth during GSR.
[0149] In addition, species-specific biomarkers exist for
microorganisms that are altered during chronic stress or disease.
These can be, for example, human biomarkers. The biomarkers can be
associated with a microorganism that inhabits or is found in an
organ or organ system that is selected from the group consisting of
mouth, gut, skin, and reproductive system. The species specific
biomarker can be characteristic of normal mouth and can be
correlated with the viability or metabolic activity of a
microorganism selected from the group consisting of Streptococcus
oralis, Streptococcus mitis, Actinornyces spp., Gemella spp.,
Granulicatella spp., Neisseria spp., Prevotella spp., Rothia spp.,
and Veillonella spp. Alternatively, the species-specific biomarker
can be characteristic of mouth in disease and can be correlated
with the viability or metabolic activity of a microorganism
selected from the group consisting of a member of the
Enterobacteriaceae family, Pseudomonas spp., Escherichia coli,
Staphylococcus spp., and Streptococcus spp. Alternatively, the
biomarker can be a species-specific biomarker for a latent
pathogenic microorganism whose population, viability, or metabolic
activity is increased during chronic stress or disease. The latent
pathogenic organism can be selected from the group consisting of
Epstein-Barr virus, JC virus, chicken pox, herpes virus,
Streptococcus spp., Staphylococcus spp., and Candida spp.
[0150] The relationship between each individual stressor and the
ten SR pathways, and thus the SR biomarkers associated therewith,
may not always be known, especially since the effects of many
stressors on particular SR pathways is not yet well studied. For
example, the effects of bird flu virus, engineered nanoparticles,
and effects of deep space and deep sea or other extreme
environments on each individual SR pathway may not be completely
elucidated.
[0151] However, most SR biomarkers associated with the 10 SR
pathways are useful targets in assays to analyze the effects of
both known and unknown stressors, such as environmental stressors
and/or diseases-related stressors. Accordingly, SR biomarkers
associated with SR pathways are suitable targets for studying the
effects of unknown stressors because they provide a
response-oriented detection strategy that does not require prior
knowledge of the stressor.
[0152] SR Biomarkers associated with the SR pathways are also
suitable targets in studying the effects of complex stressors, some
of which may be known and others of which may be unknown. These
complex, or "combined" stressors, are common in real-life
scenarios, and may include multiple known and unknown adverse
conditions. Global warming, ozone holes, human effects on wildlife,
urban pollution, natural and industrial disasters, poverty and war
are examples of complex, combined stressors.
[0153] Some asymptomatic health changes may not have a reproducible
molecular mechanism. In this case, the pattern of molecular damage
may be random and not classifiable by traditional biomarkers. SR
biomarkers may provide a solution for classification of such
difficult-to-define health changes, which may be important for
disease risk assessment and disease prevention. A panel of SR
biomarkers that interrogate all SR pathways (panoramic SR
signature) can classify random molecular damage through a
reproducible increase in global SR activity. The SR increase is
indexed by a cumulative increase in the level of all the SR
biomarkers. Panoramic SR signatures can be detected using the
preferred SR biomarkers listed in FIG. 2. Since global rather than
individual SR is measured, the biomarkers may be measured all
together, using pooled biomarker-binding molecules, called here
fusion assay or combined SR biomarker assay.
[0154] SR biomarkers can identify new molecular targets for the
detection and treatment of diseases and stressor effects. SR
biomarkers are functionally linked to particular SR pathways (see
biomarker specifications in FIG. 2). Therefore, a SR signature may
imply a "Pathway signature", a pattern of amounts and types of
activated SR pathways. Pathway signatures may be used to deduce the
nature of molecular damage caused by a health disorder, and
indicate the nature of the causative stressor or disease. Based on
established functional links, a pathway signature may also predict
which other pathways and molecules might be affected by the health
disorder. Based on this analysis, new molecular targets for
diagnostics and treatment may be identified.
Expression of SR Biomarkers
[0155] As shown in FIG. 2, many SR biomarkers are expressed in
different types of organisms. Particularly preferred SR biomarkers
are expressed in all five different types of organisms as shown in
FIG. 2: vertebrate animals (1); invertebrate animals (2); protists
and fungi (3); bacteria (4); and plants (5).
[0156] In one example, SR biomarkers that are highly conserved in
protists and fungi as well as bacteria can be assayed to analyze
stress responses in all three different types of microorganisms. By
targeting highly conserved biomarkers (or fragments thereof that
are highly conserved), assays can be developed that are useful to
perform SR profiling of different sample types from different
organisms exposed to different stressors using the same
reagents.
Selection of SR Biomarkers
[0157] Optimal criteria for the selection of SR biomarkers are
described below:
[0158] (1) The biomarker has a functional role in SR biomarker
pathways associated with stress. This criterion assures that the
biomarker has a physiological association with a stress
response.
[0159] (2) The biomarker has a near-constant level in healthy as
well as in acutely stressed biological systems. This criterion
identifies biomarkers with a stable baseline that have low
variability in the absence of stress.
[0160] (3) The biomarker level is significantly modulated in at
least some chronically stressed biological systems. This criterion
identifies biomarkers with highly variable levels in stress.
[0161] (4) The biomarker is significantly modulated by different
types of stressors. This criterion identifies biomarkers with a
broad range of stress sensitivity.
[0162] (5) The biomarker level preferentially increases rather than
decreases in chronically stressed biological systems. This criteria
identifies biomarkers that can be combined to provide a global
(cumulative) biomarker level that is elevated in stress. Global
biomarker levels may be more stress-sensitive and easier to measure
than individual levels for multiple biomarkers.
[0163] (6) The biomarker is present in a plurality of biological
systems (e.g., ecosystems, species, cell types, tissues, bodily
fluids and secretions.) This criterion identifies biomarkers with a
broad range of applicability.
[0164] (7) The biomarker's structure and function have been
strongly conserved during biological evolution. This criteria
identifies biomarkers with a universal utility as targets from
multiple biological systems so that the biomarkers can be detected
using the same biomarker-recognition method, e.g. a cross-reactive
antibody.
[0165] (8) The biomarker can be measured in minimally invasive
samples from biological systems that can be simply collected and
processed, e.g. without gloves and refrigeration. This criterion
identifies biomarkers that are easy to measure.
[0166] These criteria constitute a systematic method for selecting
SR biomarkers that are suitable for practical analysis of
stress.
[0167] In one example, candidate SR biomarkers are first selected
based on their association with universal SR pathways and
expression in multiple taxonomical groups of organisms. Next, SR
biomarkers are selected for inclusion in a SR biomarker panel that
are suitable for practical assay formats based on their expression
characteristics in assay samples such as ubiquitous distribution,
consistent localization, abundant cellular levels and significant
differences between reference control and stressed samples. The
average SR biomarker levels in the panel are converted to "scores"
and SR profiles, either of the SR biomarkers or of the SR pathways
to which they are associated, provide a highly reliable
classification of stress.
[0168] Once a panel of SR biomarkers is evaluated based on their
multi-dimensional variability (i.e., associated with multiple SR
pathways in multiple organisms and in multiple sample types), a
"minimal SR biomarker panel" can next be constructed by converting
the SR biomarker measurement data into SR pathway signatures that
reveal molecular mechanisms of stress.
[0169] As shown in FIGS. 2 and 3, there are many known SR
biomarkers associated with one or more SR pathways. These and other
SR biomarkers may be selected for targeting in an assay to detect
homeostatic perturbations based on the criteria listed above. SR
biomarkers that satisfy all the optimal criteria are considered to
have "high classification power" (i.e. their ability to distinguish
one source of stress from another.) Selection of biomarkers via
specified criteria provides a hypothesis-driven assay design,
rather than a discovery-driven assay design such as gene arrays
that typically provide large data sets with low information
content, which may not be useful in identifying biomarkers with
high classification power.
Construction of SR Biomarker Panels
[0170] Although detection of any of the aforementioned biomarkers
individually may be somewhat useful in monitoring homeostatic
perturbations of a subject biological unit or organism, it is
preferred to construct a panel of selected biomarkers for separate
or simultaneous detection, wherein the combined results are capable
of distinguishing one stressor from another, and also capable of
compensating for individual "blind spots" in stress sensitivity. As
used herein, "stress response profiling" refers generically to the
detection of one, more than one, or a panel of SR biomarkers.
[0171] A panel should preferably satisfy the following criteria:
selected biomarkers should provide for improved stressor
differentiation, and should be detectable using a universal
detection strategy if desired (e.g. a pool of antibodies with
different specificities that reacts with all selected biomarkers in
the panel under the same reaction conditions.)
[0172] For example, a panel of SR biomarkers, at least one of which
is associated with each of the eight preferred or alternatively all
ten SR pathways discussed above, can be selected for detection in
an assay to analyze random molecular damage as a function of a
reproducible increase in global stress response activity. The SR
biomarker levels that are measured in the SR biomarker assay can
thereafter be converted into a "profile" (i.e. a complex
multi-dimensional pattern of information) associated with the SR
biomarker panel, i.e. an "SR biomarker profile."
[0173] In a specific example described in more detail elsewhere
herein, the data generated from an assay in which the level of all
40 of the preferred SR biomarkers in FIG. 2 is individually
determined and can be manipulated to produce output in the form of
a signature that is unique to the panel and useful to easily detect
changes in the signature attributed to the presence of homeostatic
perturbations associated with different stressors.
[0174] It is important to note that the panel of 40 biomarkers
listed in FIG. 2 was developed by first performing an extensive
literature review to identify a large panel of biomarkers that
satisfied most if not all of the ideal criteria, and then by
validating the selection based on laboratory analysis of reference
samples from a broad range of biological systems (both the types
and sources of samples) that were known to be either normal or
chronically stressed by many different types of stressors. This
complex study resulted in the compilation of a panel of 40
biomarkers that were useful to generate SR biomarker signatures
from virtually any sample type (blood, saliva, skin, etc.) from any
biological unit (virus, microbe, fungus, invertebrate, vertebrate,
mammal, human) suffering from any type of stress (heat, cancer,
infection, etc.)
[0175] More specifically, this panel and the SR biomarker assay
taught herein was shown to enable stress response profiling in 11
species of mammals and birds (human, 4 species of dolphins, 3
species of whales, elephant, chicken, duck), multiple cell types
(epithelial cells, fibroblasts, endothelial cells,
monocytes/macrophages, lymphocytes, seminal cells, neurons,
astrocytes, glial cells, microbial cells), multiple tissues (the
skin, the brain, the breast, the prostate, the tonsil, the thymus)
and multiple body fluids (blood, saliva, semen, breast milk).
[0176] The availability of this universal SR biomarker panel
enables the validation of any newly constructed candidate panels of
biomarkers that have been compiled according to the teachings
herein that are more specifically tailored to particular sample
types, biological units and stressors. Such candidate panels can
easily be optimized against reference samples to eliminate
individual SR biomarkers with insufficient variation and/or
sensitivity.
[0177] It should also be apparent to anyone of skill in the art
that the exemplified panel of 40 SR Biomarkers can be used to
validate smaller sized panels consisting of less than all 40 SR
Biomarkers. For example, an appropriate statistical method can be
used to select the "best" SR Biomarkers for inclusion in a panel.
For example, principal component analysis (PCA) can be used to
determine variability in SR biomarker expression profiles in
reference samples (i.e., known normal and known abnormal samples).
The PCA data can be used to calculate a variability index.
[0178] For example, a panel can be constructed by selecting SR
Biomarkers with the highest variability index values and using
appropriate statistical method to determine the classification
power of the panel for reference samples. For example, hierarchic
clustering can be used to determine the classification power of SR
biomarker panels. The classification power corresponds to the
reliability with which the SR biomarker panel discriminates between
the normal and the abnormal samples. In other words, the
reliability shows how "good" is the SR biomarker panel in
separating normal and abnormal samples. The reliability level can
be selected by the end user of the panel. Accordingly, as few as
two SR Biomarkers can constitute a panel and provide enough
information to classify abnormal samples. Preferably, however, the
panel will include at least 5 SR Biomarkers with the highest
variability indices in reference samples.
Two-Tier Test
[0179] The SR biomarker assays of the present invention can also be
performed in a two-tier approach. The first tier is a combined SR
biomarker assay (i.e., simultaneous measurement of all SR
biomarkers in a single assay system, or pooling results from
individual SR biomarker measurements.) This first tier is a
low-resolution test to first discriminate between samples/subjects
with different levels of stress. The second tier is a
high-resolution test to further characterize the stress. This type
of two-tier testing approach is ideally suited for performing a
quick triage of samples for rapid assessment of health disorders
and other manifestations of chronic stress (Tier 1), followed by a
more thorough analysis to facilitate intervention (Tier 2.) Such a
test format is depicted in FIG. 4.
[0180] As shown in FIG. 4a, in the first tier, SR biomarkers can be
analyzed on a global basis in a combined SR biomarker assay by
measuring all SR biomarkers in a SR biomarker panel simultaneously
by pooling detectable SR biomarker-specific binding molecules
together. If a persistent homeostatic perturbation is detected,
then an assay of the individual SR biomarkers is performed to
measure each SR biomarker individually. From the results of the
individual SR biomarker assays, a SR biomarker profile can be
constructed, which is useful for a more detailed analysis of the
stress. As shown in FIG. 4b, if the result of the SR biomarker
assay is the identification of a threat to health, then the sample
and the subject from whence it came can be referred for
differential diagnosis and therapeutic intervention.
SR Biomarker Binding Molecules
[0181] SR biomarkers may be detected using a plurality of SR
biomarker-specific binding molecules. SR biomarker-specific binding
molecules can include, but are not limited to, antibodies,
receptors, and aptamers.
[0182] Antibodies may be commercial reagents, or newly developed
reagents. To achieve improved measurement of SR biomarkers, new
antibodies may be prepared using several specifications: (i)
antibodies raised in the same host. Hosts may be mammals or
chickens; (ii) antibodies specific for highly conserved epitopes on
the SR biomarkers; (iii) antibodies cross-reactive with multiple
species; and/or (iv) antibodies reactive with all SR biomarkers
under identical immunochemical reaction conditions.
[0183] Exemplary antibodies and their optimized concentration for
the two different types of SR biomarker assays (i.e., multiple-SR
biomarker assay and SR biomarker assay) are shown in FIG. 5. As
shown, the antibody levels for the combined SR biomarker assay (a)
are optimized for all reference specimens, and the antibody levels
for the combined SR biomarker assay (b) are optimized for spotted
dolphins (Example 4.) Aptamers that are useful as binding partners
in SR biomarker assays may be selected from a random
oligonucleotide pool based on (i) high affinity for highly
conserved molecular regions in the biomarkers, and (ii) optimal
binding to the biomarkers under the specific assay conditions (iii)
identical binding conditions for aptamers to all biomarkers.
Signaling
[0184] In order to be detectable, the SR biomarker-specific binding
molecules must be capable of directly or indirectly being
detectable. Detectable signals can include, but are not limited to,
photonic, electric, magnetic, or mechanical signals.
Assay Formats
[0185] Assays types that are useful to perform SR biomarker assays
include, for example, immunochemical staining of cells and tissues,
flow cytometry, enzyme linked immunosorbant assays (ELISA), and
immunoprecipitation. Immunoassays can be performed as a sandwich
assay or a competitive assay. It should be evident that when the SR
biomarker is, for example, a protein, any assay that is capable of
specifically and sensitively detecting the presence and amount of
that protein in a sample can be used in the practice of the present
invention based on well known protein assay principles.
SR Biomarker Quantification and Data Analysis
[0186] SR biomarker levels can be quantified in assays in which at
least one SR biomarker is individually measured. Quantification
methods may include subjective and objective methods. Subjective
methods may include a visual scoring of colored signals. Objective
methods may include computerized image analysis and instrumental
counting of magnetic, electric, photonic, mechanical and other
signals.
[0187] Quantitative SR biomarker measurements (i.e., "raw data")
may be processed prior to statistical analysis. Raw data processing
methods may include normalization and log-transformation.
Normalization may include computing a ratio between raw data and
baseline. The baseline may be general, e.g., it may be based on an
average across a population of samples from healthy biological
subjects/systems. Alternatively, the baseline may be personal,
e.g., it may be based on an average across time-series data for
samples from one biological subject/system. A plurality of
statistical methods may be used to provide classification of
homeostatic perturbations, which in turn may be directly related to
health changes/health disorders, or disease risk.
[0188] Known methods for data analysis include basic statistical
methods such as range, average and standard deviation that are
useful for analyzing the distribution of one-dimensional data such
as individual SR biomarker scores, panel scores and combined SR
biomarker scores. Statistical tests such as the Wilcoxon's rank sum
test (nonparametric analysis of variance) are useful for evaluation
the statistical significance of differences between sets of data,
such as SR biomarker scores for control and test samples, and for
testing potentially confounding effects of sampling variables.
[0189] Spearman's correlation test may be used to test
reproducibility of data collection method by comparing fit between
duplicate data points. Multivariate statistical methods can also be
used for multi-dimensional data such as SR biomarker profiles and
SR pathway profiles and may include principal component analysis,
hierarchic clustering, regression analysis and neuronal nets.
Hierarchic clustering may be used to determine relatedness between
SR biomarker/pathway profiles in test and reference samples, e.g.
it maybe be used to decide whether a test sample is from a normal
or a stressed organism, or it may be used to find out which SR
biomarkers or SR pathways have coordinated regulation. Principal
component analysis may be used to index variability in SR
biomarker/pathway profiles in order to point out most activated
biomarkers/pathways that may be indicate the molecular mechanism of
homeostatic perturbations. Most variable biomarkers contain most
information about homeostatic perturbations and may be used for
constructing minimized SR biomarker panels.
[0190] As disclosed herein, continual data can be also converted in
simple-to-use "negative" and "positive" data based on a cut-off
data point calculated as: C.about.x+2s, where_x is the average data
in control samples and s is the standard deviation of control This
categorical scoring provides a simplified interpretation of SR
biomarker pool scores that is useful for a rapid sorting of samples
into "normal" (negative data) and "stressed" (positive data), when
the actual data value is not important. This approach is similar to
sorting people into "tall" and "average" based on a cut-off value
for the height.
[0191] As disclosed herein, data related to SR biomarkers and SR
pathways may be fused with non-biomarker data sets in order to
obtain improved power of classification and/or improved risk
prediction. Non-biomarker data sets provide additional information
about biological systems and their environment. Non-biomarker data
sets may include health histories and results from a plurality of
health and environmental tests. These tests may include blood
pressure, cholesterol levels, glucose tolerance, hormonal levels,
liver function, infectious agents, genetic tests, cognitive
neuropsychological tests, psychological stress tests, or
environmental quality tests.
[0192] The following description presents an exemplary calculation
of an SR pathway profile: SR biomarker profiles are converted into
SR pathway profiles using the following formula:
Z = [ Z 1 Z 10 ] .apprxeq. Z 1 = f 1 , 1 y 1 + f 1 , 2 y 2 + + f 1
, 40 y 40 Z 10 = f 2 , 1 + f 2 , 2 y 2 + + f 2 , 40 y 40 or
##EQU00001## Z p , t = p = 1 10 i = 1 40 f pi yi ##EQU00001.2##
where: Z is a SR pathway profile; Z.sub.p is the SR pathway profile
for the p-th pathway, p=1, . . . , 10; y.sub.i is the i-th SR
biomarker's score, i=1, . . . , 40; and f.sub.pi is a constant that
indicates the relatedness between the p-th SR pathway and the i-th
SR biomarker.
[0193] The f.sub.pi value is determined empirically. FIG. 2 shows f
values for the 40 preferred SR biomarkers and the 10 universal SR
pathways. SR biomarkers with a function in or an association with a
SR pathway were assigned f=1, and biomarkers without were assigned
i=0. In general, /can have other values than 0 and 1 to indicate
different modes of relatedness.
[0194] The following description presents an exemplary calculation
of a variability index for SR biomarkers, which can be used to
construct a SR biomarker profile. As disclosed herein, the
multi-dimensional variability of SR biomarkers may be indexed to
identify most variable SR biomarkers, which might be useful in
constructing minimized SR biomarker panels. The variability index
for SR biomarker profiles may be calculated using the following
formula:
v.sub.i=1.sub.1ix.sub.1i+1.sub.2ix.sub.2i
where; v.sub.i is the variability index for the i-th SR biomarker
(i=1, . . . , 40); and l.sub.1i and l.sub.2i are the pc1 and pc2
eigenvalues for the i-th SR biomarker; and x.sub.ii and x.sub.2i
are the absolute values of pc1 and pc2 eigenvectors for the i-th SR
biomarker.
[0195] The eigenvalues and eigenvectors related to pc1 and pc2 are
determined using principal component analysis of SR biomarker
profiles.
[0196] The following description presents an exemplary calculation
of a variability index for SR pathways. As disclosed herein, the
multi-dimensional variability of SR pathways may be indexed to
identify the most variable SR pathways, which is useful in
revealing the molecular mechanism of homeostatic perturbations. The
variability index for SR pathways may be calculated using the
following formula:
v.sub.p=1.sub.1px.sub.1p+l.sub.2px.sub.2p where;
v.sub.p is the variability index for the p-th pathway (i=1, . . . ,
10); 1.sub.1p and 1.sub.2p are the pc1 and pc2 eigenvalues for the
p-th pathway; and x.sub.1p and x.sub.2p are the pc1 and pc2
eigenvectors for the p-th pathway.
Sampling
[0197] Samples that are useful for performing SR biomarker assays
may include biological and non-biological samples. Biological
samples may be solids, fluids, secretions, exhalations from live
and/or dead biological systems. Fluids may include saliva, sweat,
tears, breast milk, vaginal secretions, semen, urine, blood, plant
sap, natural cellular suspensions, manufactured cell suspensions.
Solids may include body tissues, eggs (birds, amphibians, fish, or
invertebrates), and microbial bodies (molds, mushrooms, microbial
mats, or plankton). Non-biological samples may include materials
that might have been previously associated with, and modified by,
biological systems including stromatolites, fossils, or materials
of nonterrestial origin. Samples may be collected and processed
using a plurality of known methods.
[0198] Samples can be obtained from any of a number of different
sources, such as cells, tissues, and/or an organism such as a
vertebrate organism. The vertebrate organism can be a fish, an
amphibian, a reptile, a bird, or a mammal. If the vertebrate
organism is a mammal, it can be a human or a dolphin, or a socially
or economically important mammal selected from the group consisting
of a dog, a cat, a cow, a sheep, a pig, a horse, a donkey, a mule,
and a goat. If the vertebrate organism is a bird, it can be a
socially or economically important bird selected from the group
consisting of a chicken, a turkey, a duck, a goose, a pigeon, a
parrot, and a parakeet. Alternatively, the bird can be a bird
normally living in the wild. Alternatively, the organism can be a
plant, such as a socially or economically important plant selected
from the group consisting of wheat, corn, rye, oats, barley,
lettuce, cabbage, apples, potatoes, tomatoes, peas, oranges,
pineapples, lemons, grapes, plums, pears, and bananas. In another
alternative, the organism can be an alga.
Assay Devices
[0199] The SR biomarker assays described herein can be adapted to
be performed by lay users without a laboratory. The users may be
health care professionals in point-of-care facilities or lay
consumers in field conditions. The devices may have multiple
embodiments including single-use devices, simple reusable devices
and computerized biomonitors. The single-use devices, similar to
over-the-counter lateral flow assays for pregnancy, enable
subjective combined SR biomarker assays to be performed that
indicate general stress, such as that caused by a health disorder
or the risk or absence thereof. Simple reusable devices also enable
objective SR biomarker assays that provide a refined or enhanced
indication of stress, and may also enable remote data
processing
Assay Kits
[0200] Another aspect of the present invention is that the SR
biomarker assay can be provided in a kit which allows for more
convenient laboratory-based SR biomarker analysis. The kits may
include a plurality of components including reagents, supplies,
written instructions, and/or software. The kits may have a
plurality of embodiments including laboratory kits and mail-in
kits.
[0201] Laboratory SR biomarker assay kits may enable tests for
individual and/or combined SR biomarkers in a laboratory. The kits
may have a plurality of embodiments based on applications and
methods for biomarker detection. The kits may also be designed for
use with a plurality of samples including exhaled breath, bodily
fluids and secretions, tissues, cultured cells. Kit components can
include: (1) sampling supplies and instructions; may include sample
collectors and storage containers, sample processing tools,
fixatives and user instructions; (2) controls; may be biological or
synthetic samples of tissues or biofluids with baseline and
elevated biomarker levels; and (3) biomarker-binding molecules
including antibodies, aptamers, receptors, or other specific
binding partners.
[0202] SR biomarker-specific binding molecules may be provided as
pre-made, ready-to-use reagents for detecting individual or
combined SR biomarkers. The reagents may be optimized for
tissue-specific applications. Alternatively, SR biomarker-specific
binding molecules may be provided as concentrated reagents with
suggested working concentrations for different applications. A pair
of SR biomarker-specific binding molecules may be provided to
enable double-positive SR biomarker recognition. Conjugated SR
biomarker-specific binding molecules may also be provided, such as
SR biomarker-specific binding molecules conjugated to biotin,
fluorescent dyes or quantum dots.
[0203] The kits can include secondary reagents. Secondary reagents
may be antibodies, enzymes, labels, or chemicals and may enable a
complete SR biomarker panel assay.
[0204] The kits can further include software. Software may include
a training video that may provide additional support including
demonstration of SR biomarker assays, examples of results, or
educational materials for performing SR biomarker assays.
[0205] Mail-in SR biomarker assay sample collection kits enable
sample collection and shipment to a remote laboratory for testing.
The remote laboratory may perform SR biomarker assays using assay
kits, and provide test results to the user. Potential users include
lay consumers, and professional users in the field or point-of-care
facility. Mail-in tests may have a plurality of embodiments based
on samples and applications. The samples may include body fluids,
secretions and tissues from different types of organisms including
people, animals, plants, microorganisms. Components can
include:
[0206] (1) Supplies and instructions for collecting and fixing
samples to enable mailing and subsequent laboratory analysis of SR
biomarkers. The supplies may include sample collectors, sample
processing tools and supplies, fixatives, storage containers. The
supplies may enable preparation of stabilized samples of whole
biofluids and tissues; or cellular spreads made from biofluids.
Technical support via telephone and a website.
[0207] (2) Mailing supplies to enable sending samples to a remote
laboratory that performs SR biomarker tests. The supplies may be a
pre-addressed regular mail envelope.
[0208] (3) Results provided by mail. The mail may be a letter, an
email, information posted on a website. The website may have health
tips and links to health care and product providers. The links may
be advertisements.
Exemplary SR Biomarker Assay Kit Format for Humans
[0209] The SR biomarker assays can be configured into a test kit
for the use at home or in doctor's office including: a small,
hand-held device similar to a digital thermometer. The device
includes a disposable module for sample uptake and reagent storage
(refills sold separately), and a re-usable module for signal
detection and result display that may involve optical and
electronic components. No training required for sampling and test
operation. Real-time results (1-3 minutes). Simple readout of
results, e.g. percent above baseline or an artificially color-coded
scale from green to red.
[0210] Alternatively, this assay can be performed on a test strip.
One end is briefly put to mouth to wick up saliva. Result (SR
biomarker level) is indicated by a color change in the result area
of the strip (litmus test-like). Disposable.
[0211] It can also be formatted on a sampling strip (a plastic
microscopy slide), a collection cup, a plastic spatula, a small
pouch with fixative (alcohol), instructions for making and fixing a
saliva smear, a mailing envelope/packaging addressed to testing
company. Fixed slides can be send by regular mail (SR biomarkers
are stable). The testing company processes the slide and sends
results back via self-addressed envelope and/or the results are
posted on the testing company's website (via personalized access
code).
[0212] Software, or a web access to the testing company website,
with regularly updated information on health-promoting and
health-risk factors that can be detected by the SR biomarker assay,
health tips, and links to health products and services (paid
ads).
[0213] Alternatively, the assay may be configured as a lab test kit
including instructions and supplies for preparing saliva smears on
microscopy slides. Alternatively, saliva smear could be prepared by
a doctor's assistant during a medical exam, fixed with an alcohol
spray (like a PAP smear) and send to a processing lab. The kit may
include anti-SR biomarker antibodies and instructions for diluting
and mixing the antibodies to make the combined SR biomarker reagent
suitable for staining of human saliva. The kit may also include
microscopic slides with positive and negative controls (saliva
smears with normal and stressed cells) and staining instructions,
result interpretation, website link for technical assistance.
[0214] This assay configuration is well suited for the following
applications:
[0215] Consumer diagnostics: Self-administered health test for home
use. Personalized monitoring of health risk factors such as diet,
exercise, health supplements, urban pollution, pesticides, sun
exposure, geographical location, work environment, relationships,
etc.
[0216] POC diagnostics: Health test administered in doctor's office
during routine medical checkups (along with routine vital
signs).
[0217] Personalized medicine: self-administered stress response
test to gauge a patient's reaction to a medical drug (or device).
Early identification of adverse effects.
[0218] Complementary/alternative medicine (CAM): Currently, there
is no widely accepted objective test to measure effects of CAM
treatments such as acupuncture, cold laser, homeopathic/herbal
supplements, physical therapy, massage, meditation. At present, the
outcome of CAM treatments is monitored using self-reported pain,
stress, energy levels at each office visit. Objective monitoring is
challenging because CAM modalities combine multiple factors with
physical, chemical, biological and psychological effects on human
physiology. SR biomarkers are optimally suited to monitor CAM
effects because they were developed for detecting complex
combinations of diverse stressors. SR biomarker assays can be used
to for initial assessment of patient's stress level, and to
monitor/guide CAM treatments.
[0219] Mental health diagnostics and treatment monitoring:
Currently, mental health diagnostics is largely based on a battery
of neuropsychological tests that cannot provide early, preclinical
signatures of mental disorders. Mental disorders are associated
with increased levels of chronic physiological stress that can be
objectively measured by SR biomarker assays to generate SR
biomarker profiles. SR biomarker assay-based classification of
demented AIDS patients in Example 7 indicates that saliva-based SR
biomarker profiling could be used for early detection of
neurodegenerative disorders, before the emergence of
neuropsychological cognitive deficits. SR biomarkers detect
increased cellular stress in saliva during increased psychological
stress. This indicates that SR biomarker assays can be used to
measure stress levels as a part of the patient's initial mental
health assessment, for early detection of post-traumatic stress
disorders (PTSD), and to monitor/guide treatments (drugs,
counseling). SR biomarker assays can be particularly useful for
PTSD screening in people with high risk (soldiers returning from
deployment, battered women).
[0220] Dental health: SR biomarker assays of saliva/dental plaque
is applicable for early detection of gum disease, a serious
disorder linked to increased risk of diabetes and cardiovascular
disease. Currently, periodontal disease is diagnosed by dentist
based on clinical symptoms, and a molecular test for early
detection or prediction is not available. Rapid combined SR
biomarker assays can be delivered in dentist's office during
routine oral exams, or could be made into self-administered
periodontal test for home use. Including SR biomarkers for the
microbial activation pathway might improve the sensitivity of gum
disease detection. The SR biomarker assay device might use a dental
floss for the collection of saliva plus dental plaque and possibly
also to directly indicate test results.
[0221] Field diagnostics: Health test administered by non-medical
personnel during emergency calls or mass health crises due to
natural, industrial and terror disasters civilian (e.g. after
Hurricane Katrina).
[0222] Occupational safety: health biomonitoring in environments
with high levels of physiological stressors (heat, radiation,
noise, gravity, oxygen, toxins, pathogens, psychological stress)
such as haz-mat personnel, fighter pilots, military and police,
astronauts.
[0223] Environmental safety: Monitoring health outcomes in people
with chronic exposures to industrial chemicals used in industrial
and agricultural processes, urban pollution etc. SR biomarker
assays can be particularly useful for assessing safety of products
with unknown biological effects such as engineered
nanoparticles.
Exemplary SR Biomarker Assay Applications
[0224] It should be readily apparent that the systems and methods
described herein have universal applications to analyzing virtually
any type of stress from any source of stress in any organism. The
applications listed below are merely representative of the broad
range of uses of the present invention.
[0225] Health screening: The SR biomarker assays may be used to
detect elevated SR biomarkers levels that indicate adverse health
changes. Adverse health changes may be a non-specific, pre-disease
condition such as stress, or an early-stage of a specific disease.
Such health screening may be useful to detect asymptomatic health
changes for purposes of classifying difficult-to-define health
changes, which may be important for disease risk assessment and
disease prevention.
[0226] The SR biomarker assay can be performed with non-invasive
samples including body fluids and secretions, exhaled breath,
tissues. The body fluids may include saliva (people, pets, farm
animals) and milk (cattle). Body fluids may be processed into cell
smears, cell-free fluids or homogenates. The test may be used
during routine (preventative) health exams in human and veterinary
medicine, agricultural care, wildlife management.
[0227] War veterans screening: The SR biomarker assay can provide
early indication of asymptomatic post-traumatic stress disorders
and brain trauma in soldiers returning from a deployment in a war.
Similar screening tests can be performed in populations who may be
subject to similar stressors, such as first responders in a
disaster.
[0228] Personalized product/procedure safety test: Individuals may
have different reactions to products and procedures that the
average reaction determined during FDA-required safety testing. The
SR biomarker assay can be used for personalized assessment of
health care products (drugs, supplements, diets, devices, implants)
and procedures (surgery, anesthesia, radiation therapy, imaging;
complementary/alternative medical procedures including physical
therapy, massage, acupuncture, cold laser, meditation, counseling).
Also animal/crop/ecosystem management procedures including habitat
change, handling procedures.
[0229] Sperm bank test: The SR biomarker assay of semen to assess
sperm health can be performed along with conventional methods to
assess sperm number, viability, and motility.
[0230] Safety test for new products and procedures: The SR
biomarker assay can be use to screen candidate products and
procedures such as medical drugs, pesticides, water treatments, and
guide design changes towards reducing and eliminating stressful
biological effects. The SR biomarker assay is applicable at
multiple stages of safety testing: in vitro cellular tests,
laboratory animal testing, clinical trials, environmental tests in
different species. SR biomarkers can be particularly useful for
novel products with unknown biological effects such as
nanomaterials.
[0231] Cancer tests: Cervical cancer screening can be performed by
SR biomarker staining of cervical cell smears for improved
identification of abnormal cervical cells that would replace or
supplement the standard PAP test. Prostate cancer screening can be
performed by SR biomarker staining of seminal cell smears for
identification of abnormal prostatic cells. Non-invasive cancer
screening can be conducted by performing SR biomarker assays of
saliva for detecting asymptomatic cancers. Detection of cancer and
micrometastatic disease in blood samples, biopsy tissues and tumor
tissues, is enhanced by supplementing standard cancer tests with SR
biomarker assays.
[0232] Water quality test: SR biomarkers are applicable to aquatic
microorganisms (algae, fungi, protozoa, bacteria). SR biomarkers in
aquatic microorganisms are inducible by a variety of physical,
chemical and biological water quality factors including temperature
changes, oxygen levels, chemical pollutants, biotoxins, pathogens,
pH changes. Multi-tier biomarker sensors may be deployed in situ,
to monitor SR biomarker levels in freshwater reservoirs and
water-treatment facilities.
[0233] Prenatal health tests: SR biomarker assays of embryonic
cells obtained during in vitro fertilization and amniotic sampling,
supplementing standard genetic testing can be use to enhance
prenatal testing.
[0234] Differentiation between outcomes of health disorders: SR
biomarker assay can also be useful in discriminating between
progressive and non-progressive forms of disease. A progressive
form of a disease is more severe and widespread (e.g. metastatic
cancer) and therefore likely to be associated with a different SR
biomarker signature than a non-progressive form of the disease. SR
biomarker assays can discriminate between prostate tumor cells with
low and high Gleason scores. The Gleason score is a traditional
method for discriminating between prostate tumors with low and high
disease severity. SR biomarker assays can also discriminate between
brain cells from AIDS patients with and without cognitive deficits.
Cognitive deficits are a traditional method for identifying a more
progressive form of AIDS, so-called neuroAIDS.
[0235] Diagnostic and therapeutic target identification: SR
biomarker assays can indicate preferred biological targets of
environmental stressors and/or disease-related stressors that can
be used for early detection of stressors, for improved protection
against stressors, and for monitoring stress mitigation measures.
Increased levels of SR biomarkers may show which species in
ecosystems, and cells in organisms, were preferred targets of
stressors, i.e. most impacted by stressors, most stress sensitive
("canary in a coalmine"). For example, using the methods of the
present invention, keratinocytes are the preferred target of
environmental stressors and disease in the skin. As shown in
Example 5, tumor cells with a high Gleason score and prostatic
intraepithelial neoplasia (PIN) cells are preferred targets of
prostate cancer in the prostate. Glandular epithelial cells were
the preferred target of breast cancer in the breast; such cells are
also the preferred target of HIV and HTLV in the breast (Example
6). Multiple cell types and microanatomical areas in the brain were
shown to be targeted in AIDS (Example 7). In case of beta-endorphin
(a preferred SR biomarker), the targeted cell was shown to be
perivascular microglia in the gray matter of frontal cortex.
Salivary epithelial cells and microbial cells were shown to be the
preferred target during grieving stress (Example 18).
[0236] Therapeutic agent screening: SR biomarker assays can be used
to screen agents for their ability to alter homeostasis. The agent
to be screened can be a protein, a peptide, a peptidomimetic, a
nucleic acid, a steroid, an alkaloid, a terpene, a monosaccharide,
a disaccharide, a carbohydrate larger than a disaccharide, an amino
acid or derivative thereof, a nucleic acid base, a nucleoside, or a
small molecule that is other than a steroid, an alkaloid, a
monosaccharide, a disaccharide, a terpene, an amino acid or
derivative thereof, a nucleic acid base, or a nucleoside.
EXAMPLES
Example 1
Construction of a SR Biomarker Panel
[0237] This experiment provides an exemplary method for
constructing a SR biomarker panel that is useful for a broad-based
analysis of persistent homeostatic perturbations (i.e., "stress").
Although as described below, expression levels of SR biomarker
proteins are exemplified, the same assay principles could easily be
adapted to a nucleic acid-based assay to measure, for example, mRNA
encoding these proteins, which one would expect to be up-regulated
when the associated SR pathways were activated.
[0238] Candidate SR biomarkers. Approximately 2000 articles related
to stressor effects on humans, animals, plants and microorganisms
were compiled from peer-reviewed scientific literature.
Meta-analysis of the articles was used to select candidate
biomarkers based on two criteria:
[0239] (1) Association with one or more universal SR pathways.
[0240] (2) Expression in multiple species of animals. Preferred
candidate biomarkers were expressed in all taxonomic groups
(vertebrate animals, invertebrate animals, protists and fungi,
plants and bacteria.)
[0241] Assay Format. Immunochemical staining was chosen as a
practical assay for the measurement of SR biomarkers, because
methods and reagents for immunoassays are readily available and
economical. To facilitate reactivity with candidate SR biomarkers
and control molecules in different types of samples, the antibodies
used for the immunoassay were known to be cross-reactive with many
taxonomic groups of animals, and known to react with routinely
preserved tissues (fixed in formalin, stored at room temperature.)
The description and optimal concentrations of antibodies against 40
SR biomarkers are listed in FIG. 5 ("single antibody.)
[0242] Assay Samples. The skin was chosen as a practical sample for
broad-based stress analysis, because skin microsamples can be
obtained from humans as well as from animals using standard,
minimally invasive biopsy procedures. Skin microsamples
(3.times.2.times.2 mm) were obtained from 85 reference subjects
with known health status -38 subjects were stressed, 47 were
healthy (control). The stressed subjects were exposed to 30
different stressors; 18 of the stressed subjects had clinical
symptoms (e.g. a wound, emaciation or disease-specific symptoms),
and 20 subjects had no visible impairments (asymptomatic or
pre-symptomatic stress). The stressors included physical stressors
(e.g., hypothermia and uv light exposure), chemical stressors
(e.g., hypoxia), biological stressors (viral, bacterial and fungal
infections; cancer; autoimmune disease; a genetic bone defect;
tissue injury; starvation; and strenuous exercise) and
psycho-social stressors (restraint, defeat, social disorganization,
and mother-child separation.) To broadly cover the biological
effects of stressors, the reference subjects represented both
genders, four age groups (infant, juvenile, adult, old age) and 8
species (humans and seven species of wild dolphins and whales). The
nonhuman animals were accidentally stressed by adverse
environmental conditions or human activities, and were used to
cover stressors that cannot be ethically studied in medical or
laboratory animal experiments, and stressors that are currently
uncommon or unknown in humans and laboratory animals (e.g.
morbillivirus and dolphin pox.) The control subjects were healthy
and not exposed to chronic stress.
[0243] SR Biomarker Selection. Three criteria were used to select
biomarkers suitable for the skin immunoassays:
[0244] (1) The biomarker expression was consistently located in the
top layer of the skin (the epidermis) indicating that only the
surface layer of the skin (3 mm skin depth in humans) can to be
sampled for the assay.
[0245] (2) The biomarker expression was ubiquitous in the epidermis
(i.e. found in nearly all cells) sampled at different body sites,
indicating that only a very small area (2.times.2 mm) was necessary
for the assay, and the sampling site could be variable.
[0246] (3) The biomarker expression level was abundant, indicating
that biomarker levels could be accurately measured using standard
immunohistochemical staining ("HIS") methods (i.e. without signal
amplification.) Preferred biomarkers met all criteria.
[0247] SR Biomarker Measurements. Quantitative immunochemical
measurements of the 40 SR biomarkers were obtained to evaluate
whether they were modulated by stress. To ensure comparable
measurements, each SR biomarker was measured in ail reference
samples in the same immunochemical experiment, and all antibodies
were applied using identical reaction conditions (buffer, reaction
time and temperature.) The staining intensity (SI) was quantified
using image analysis (Image-Pro Plus 4.1 software, Media
Cybernetics, Silver Spring, Md.; Olympus BX50 microscope with DVC
camera 1310C, Scientific Instrument Company, Sunnyvale, Calif.).
Images were captured at x100 magnification using identical
microscope and camera settings. SI was computed as SI=MOD.times.PA,
where "MOD" is the mean optical density and "PA" is the percentage
of the stained area. MOD was measured by applying a color file to
the stained area of the image. To ensure comparable MOD counts, the
same color file was applied to all samples.
[0248] For each skin sample, a SI measurement was calculated as the
average for 3 representative images of the sample. This method for
collecting SI measurements was highly reproducible (Spearman rank
correlation coefficient r=0.98, p<0.001 for duplicate scoring of
20 samples.) To facilitate statistical analysis, the SI
measurements for each biomarker were divided by the average SI
measurement of that biomarker in control samples (normalization),
and log-transformed. Base 3 was used for the logarithmic
transformation because experts in visual scoring of immunochemical
staining typically assume that a 3-fold difference in the staining
level is meaningful. The normalized and log-transformed SI
measurements are referred to herein as the "SR biomarker scores."
Based on the normalization and the base 3 log scale, score 0
represents the baseline, score 1 represents 3-fold increase
relative to the baseline etc.
[0249] FIG. 7 shows that the average expression level of the 40 SR
biomarkers in control samples was near baseline, demonstrating that
SR biomarker levels were not elevated in normal subjects.
Surprisingly, the average level of all selected SR biomarkers in
samples from stressed subjects was 2-7 fold higher than baseline
and highly fluctuated from sample to sample, which demonstrated
that the biomarker levels were more strongly elevated in some, but
not all, samples. As will be explained below, the fluctuations from
sample to sample in this experiment, which relate primarily to
differences in the source of stress, are useful to construct
profiles that are helpful to analyze the nature and characteristics
of the stress.
[0250] SR Biomarker Panel Validation. As described above, the panel
of 40 individual SR biomarkers is multi-dimensional--it is generic
to multiple organisms and multiple stressors. To simply assess the
classification power of the panel for stress (i.e., the ability of
the panel to be useful to distinguished abnormal from normal
samples), a "panel score" was calculated as the average of all 40
biomarker scores for each sample. FIG. 8 shows that the panel
scores were elevated in all stressed samples documenting that the
biomarker panel was broadly sensitive to different types of stress.
The results are summarized in Table 3 below.
TABLE-US-00003 TABLE 3 Panel scores Sample N Range Mean St. Dev.
Control 47 -0.20 to 0.09 -0.05 0.08 Stressed 38 0.4 to 1.83 1.00
0.32
[0251] The panel scores for stressed and control samples were
significantly different (Wilcoxon's rank sum test, p<0.001), and
not affected by sampling variables (Wilcoxon's rank sum test of
gender, age and species, p=0.82, 0.80 and 0.05, respectively.)
[0252] SR Biomarker Profiles. Panel scores provide only a coarse
measure of the information derived from measurement of all 40 SR
biomarkers individually. When evaluated individually for each
sample, a "profile" emerges from the pattern of SR biomarker
scores, i.e., a SR biomarker profile. As shown in FIG. 9a, each SR
biomarker score is translated to a grey-scale value, and each
column of grey-scale values represents a "SR biomarker profile" for
the control samples (left side, generally lighter grey-scale
values) and stressed samples (right side, generally darker
grey-scale values.)
[0253] SR Biomarker Clustering. To utilize the full information
content of the SR biomarker profile, multivariate statistics can be
utilized, i.e., a 40-dimensional vector whose individual components
are the 40 individual SR biomarker scores. This method is used to
determine the relatedness between the vectors using hierarchic
clustering. Results of the clustering of the SR biomarker panels in
the reference samples are also shown in FIG. 9a. As shown, the
length of dendrogram branches is proportional to relatedness of the
SR biomarker profiles, and similar profiles are grouped together in
clusters. FIG. 9a clearly shows that SR biomarker profiles in
control and stressed samples formed two separate clusters (A and
B). This result demonstrates that the 40 SR biomarker panel
distinguished stressed samples from control samples with 100%
reliability.
Example 2
Construction of a Minimized SR Biomarker Panel
[0254] In this Example, the 40 SR biomarker panel described in
Example 1 was used to construct and validate a minimized panel of 5
SR biomarkers that was capable of classifying the reference samples
with the same reliability as the 40 SR biomarker panel.
[0255] Selection of SR Biomarkers Based on High Score Variability.
The variability of SR biomarker scores in reference samples from
control versus stressed subjects was determined using principal
component analysis. The first two principal components, pc1 and
pc2, cumulatively accounted for >97% of the variability. The
variability index was calculated as:
v.sub.i=l.sub.1ix.sub.1i+l.sub.2ix.sub.2i
where; v.sub.i is the variability index for the i-th SR biomarker
(i-1, . . . , 40); l.sub.1i and l.sub.2i are the pc1 and pc2
eigenvalues for the i-th SR biomarker; and x.sub.1i and x.sub.2i
are the absolute values of pc1 and pc2 eigenvectors for the i-th SR
biomarker.
[0256] The variability index, v.sub.i for the 40 SR biomarkers is
in Table 4 below.
TABLE-US-00004 TABLE 4 Variability Index for SR Biomarker Scores #
SR Biomarker Variability Index 17 HSF-1 6.413 37 SODCu 5.776 27
Mekk-1 5.552 36 SODMn 5.389 8 Ferritin 5.062 14 Hsp40 4.990 1
Endorphin 4.951 33 Serotonin R 4.568 9 GR 4.561 29 CYP red 4.414 13
Hsp25/27 4.347 2 Caspase 8 4.258 18 HO-1 4.236 26 MT 4.063 11 Grp75
4.018 40 VIP 3.983 28 Mek-1 3.966 35 Sustance P 3.910 25 Leptin R
3.881 20 IL-6 3.844 30 iNOS 3.786 16 Hsp90 3.711 5 CYP450 3.642 4
Cox-2 3.507 34 Serotonin 3.471 31 Fos 3.433 6 Cyt c 3.393 23 IL-12
3.300 10 Grp58 2.913 38 TGF 2.877 12 GST 2.850 32 Jun 2.660 15
Hsp60 2.595 19 IL-1 2.483 22 IL-10 2.446 3 Cyclin 1.961 7 EGFR
1.758 21 IL-8 1.619 24 Laminin 1.613 39 p53 1.388
[0257] The five SR Biomarkers with highest variability index values
were selected to construct a minimized SR biomarker panel. The
classification power of the minimized panel was determined using
hierarchic clustering. FIG. 8b shows that the five SR Biomarkers
with the highest variability index values (HSF-1, SOD Cu, Mekk-1,
SOD Mn, ferritin from top to bottom in FIG. 8b) are sufficient to
classify reference samples as coming from stress or normal subjects
(i.e., "classifying stress") with the same 100% reliability as the
40 SR biomarker panel in FIG. 8a. The top four or the top three
biomarkers provide 98.8% reliability (1 false negative), the top
two provide 97.6% reliability (2 false negatives) and the top one
SR biomarker (HSF-1) provides 84.7% reliability (13 false
negatives) for classifying stress. Also as depicted in FIG. 8, each
SR biomarker profile (i.e., each column of grey-scale values)
provides a useful characterization of stress response activation in
each individual sample tested.
Example 3
SR Pathway Profiles for Analyzing Molecular Mechanisms of
Stress
[0258] In addition to the SR biomarker profiles described above in
Examples 1 and 2, SR pathway profiles can also be constructed to
more particularly analyze the molecular mechanisms of stress in
differentially activating individual SR pathways.
[0259] SR Pathway Profile Construction. To determine the molecular
mechanism of stress, "pathway activation analysis" was performed.
The principle of this analysis is the conversion of a SR biomarker
profile into a "SR pathway profile" (FIG. 1.) SR pathway profiles
are useful as indicators of the molecular mechanism of stress by
revealing which SR pathways are most activated and which SR
pathways have a coordinated regulation. SR pathway profiles can
also be used for classifying samples as being from normal versus
stressed subjects in the same manner as SR biomarker profiles.
[0260] SR pathway profiles were calculated using the following
formula:
Z = [ Z 1 Z 10 ] .apprxeq. Z 1 = f 1 , 1 y 1 + f 1 , 2 y 2 + + f 1
, 40 y 40 Z 10 = f 2 , 1 + f 2 , 2 y 2 + + f 2 , 40 y 40 or
##EQU00002## Z p , i = p = 1 10 i = 1 40 f pi y ##EQU00002.2##
where: Z is a SR pathway profile, Z.sub.p is the SR pathway profile
for the p-th pathway p=1, . . . , 10; y.sub.i is the i-th SR
biomarker's score, i=1, . . . , 40; and f.sub.pi is a constant that
indicates the relatedness between the p-th SR pathway and the i-th
SR biomarker.
[0261] The f.sub.pi value is determined empirically. FIG. 2 shows f
values for the 40 preferred SR biomarkers and the 10 universal SR
pathways. As shown, SR biomarkers with a known function in or
association with a SR pathway were assigned f=1, and biomarkers
without a function were assigned f=0. In general, f can have values
other than 0 and 1 to indicate different modes of relatedness.
[0262] Activation of SR pathways. The activation level of
individual SR pathways was indexed based on the SR pathway
variability. The variability was determined using principal
component analysis as described for the SR biomarker scores in
Example 2.
The variability index was calculated as:
v.sub.p=l.sub.1px.sub.1p+1.sub.2px.sub.2p
where; v.sub.p is the variability index for the p-th pathway (i=1,
. . . , 10); l.sub.1p and l.sub.2p are the pc1 and pc2 eigenvalues
for the p-th pathway; and x.sub.1p and x.sub.2p are the absolute
values of pc1 and pc2 eigenvectors for the p-th pathway.
[0263] The variability index for the 10 SR pathways in the 85
reference skin samples (see Example 1) is in Table 5 below.
TABLE-US-00005 TABLE 5 Activation of SR Pathways SR Pathway
Variability Index 1 Redox 1.935 2 Xenobiotics 1.796 3 Chaperoning
2.008 4 DNA repair 1.800 5 Cell adhesion 1.747 6 Cell growth 1.751
7 Cell death 1.754 8 Neuro-endocrine signaling 1.780 9 Immunity
1.802 10 Microbial activation 1.825
[0264] The variability index showed that the pathways 1, 3 and 10
(underlined) were preferentially activated by diverse stressors in
humans and animals. This result surprisingly indicates that the
dominant molecular mechanism of stress in the skin involves
misfolded proteins (the trigger for pathway 3), increased free
radicals (the trigger for pathway 1) and increased activation of
comensal and pathogenic microorganisms (the trigger for pathway
10).
[0265] As shown above, the pattern of variability index data from
all of the ten SR pathways can form the basis for construction of a
SR pathway profile.
[0266] Coordinated Regulation of SR Pathways. Hierarchic clustering
of SR pathway profiles was performed to find out which SR pathways
had similar activation patterns in stressed samples. SR pathways
with similar activation patterns are likely to have coordinated
regulation. Hierarchic clustering shows pathways with similar
activation patterns as clusters, the length of the dendrogram
branches being proportional to the relatedness in activation
patterns. FIG. 9 shows hierarchic clustering of 10 SR pathways in
the reference skin samples. The results indicate coordinated
regulation of: (i) pathways 2 and 3, (ii) pathways 4 and 10, (iii)
pathways 1, 5, 6, 7, 8 and 7, and particularly pathways 6, 8 and 9.
FIG. 9 also shows that SR pathway profiles discriminated between
stressed and control samples with the same 100% reliability as the
SR biomarker profiles in FIG. 8.
[0267] Resolution of SR Pathway Profiles. SR pathway profiles can
be constructed at different resolution levels to represent effects
of (i) different stressors (a panoramic profile of stress shown in
this Example), (ii) one stressor in many subjects (an average
profile, for example of stress related to prostate cancer in
Example 5) or (iii) one stressor in one subject (a personalized
profile, for example of stress related to prostate cancer in
Example 5.)
Example 4
Combined SR Biomarker Assay for Stress Screening in Dolphins
[0268] Wild spotted dolphins in the Pacific Ocean have been chased
and captured in nets during commercial fishing operations since the
1950s, and currently the dolphin population originally estimated as
5 million was reduced to a fraction of its original size. It is not
known how the fishing operations might affect dolphin health and
longevity. Current methods for assessing the health of a population
are based on estimated trends in abundance, mortality, and
reproductive rates. These methods are too slow to provide early
warnings of compromised health in species with long generation
times, such as the dolphin. Therefore we used a new method, the
stress response profiling, to obtain early warnings of compromised
health due to stress.
[0269] To rapidly and economically screen the 40 SR biomarker panel
in a large set of dolphin samples, the combined expression level of
all 40 SR biomarkers was measured using pooled anti-SR biomarker
antibodies The resulting measurement was called a combined SR
biomarker score. This constitutes a "Tier 1" assay as depicted in
FIG. 4.
[0270] The reference skin samples described in Example 1 were used
to validate the combined SR biomarker assay as a tool for
discriminating between samples from stressed and control subjects.
Optimal concentrations of pooled antibodies against 40 SR
biomarkers are listed in FIG. 5 ("Antibody pool.sup.a") The
immunohistochemical staining, the image analysis and the conversion
of the staining intensity measurements into normalized,
log-transformed scores was performed as described in Example 1.
Combined SR biomarker scores were about 9-fold higher in stressed
samples than in control (see FIG. 10 and Table 6 below.) The
difference was statistically significant (Wilcoxon's rank sum test,
p<0.001) and not affected by gender, age and species (Wilcoxon's
rank sum test, p=0.73, 0.80 and 0.25, respectively).
TABLE-US-00006 TABLE 6 Combined SR Biomarker Scores Sample N Range
Mean S.D. Positive Negative Control 47 -0.93-0.53 -0.07 0.39 0 47
(100%) Stressed 38 0.71-3.24 2.09 0.77 38 (100%) 0
[0271] As shown, the combined SR biomarker scores strongly
correlated with the panel scores for the 40 SR biomarker panel
described in Example 1 and FIG. 6 (Spearman's rank correlation
coefficient r=0.86, p<0.001).
[0272] Combined SR biomarker scores were divided into "negative"
and "positive" based on a cut-off score calculated as: C=x+2s,
where x is the average score in control samples and s is the
standard deviation of control scores. In reference samples, x=0.07,
s=0.39, C=0.71, negative scores were <0.71 and positive scores
were .gtoreq.0.71, see Table 6. This categorical scoring provides a
simplified interpretation of combined SR biomarker scores that is
sufficient for a rapid sorting of samples into "normal" (negative
scores) and "stressed" (positive scores), when the actual score
value is not important. This approach is similar to sorting people
into "tall" and "average" based on a cut-off value for the
height.
[0273] The combined SR biomarker scores were measured in 868 skin
samples from wild spotted dolphins using the same immunoassay assay
methods as in Example 1. Optimal concentrations of pooled anti-SR
biomarker antibodies for the spotted dolphin samples are listed in
FIG. 5 ("Antibody pool.sup.b".) Categorical scores were assigned
using the same formula for calculating the cut-off score as
described for the reference samples above. Samples with a
statistically normal distribution of scores (n=142) were designated
as "normal" samples. In these samples, x=1.17, s=0.44 and C=2.06.
Based on the cut-off score, scores in the 868 dolphins were
negative if <2.06 and positive if .gtoreq.2.06. The categorical
scoring was highly reproducible (Spearman rank correlation
coefficient r=0.96, p<0.001 for duplicate scoring of 158
samples). The categorical scores are in Table 7 below.
TABLE-US-00007 TABLE 7 Combined SR Biomarker Scores in Spotted
Dolphins Sample N Stressor Positive Negative Group 1 202 No 75
(37%) 127 (63%) Group 2 666 Yes 562 (84%) 104 (16%) Group 3a 70 Low
0 70 (100%) Group 3b 354 High 354 (100%) 0
[0274] In Table 7, the dolphins are divided into two groups based
on exposure to the stressor (i.e., the fishery.) The stressor
exposure was estimated based on the known amount of fishing
operations in the geographical areas where the dolphins lived, and
on the dolphin behavior, which is modified by the fishery exposure.
Table 7 shows that Group 2 that was exposed to the fishery had a
higher frequency of positive scores than the unexposed Group 1. The
difference was significant (Fisher's test, p<0.001.)
[0275] To investigate cumulative effects of repeated involvement in
the fishery, 424 dolphins from the Group 2 were designated as Group
3 and the amount of fishing operations was indexed in the
geographical areas where the dolphins were sampled. Table 7 shows
that dolphins with positive scores were found in geographical areas
with high numbers of fishing operations. The positive correlation
between the cumulative amount of the stressor and the frequency of
positive scores was significant (Wilcoxon's rank sum test,
p=0.0382.) These results show that the commercial fishery might be
causing stress in spotted dolphins, and the stress is proportional
to the cumulative amount of the fishery in the dolphin's
habitat.
Example 5
SR Profiling for the Analysis of Stress Related to Prostate
Cancer
[0276] Prostate carcinoma (PC) is one of the most common human
malignancies. Current diagnostic methods for PC include a blood
test for the biomarker PSA, and histological tumor grading that
provides an index of the malignancy potential of the tumor (the
Gleason score), which is used to predict the clinical outcome.
Recent efforts in PC research have been focused on the study of
genes expressed in PC. However, prostate tumor biology cannot be
fully understood at the gene transcription level because gene
transcripts typically undergo multiple post-transcriptional and
post-translational events before they yield functional proteins
that play roles in tumor formation and progression. Consequently,
protein-based methods such as the stress response profiling, have a
greater potential to bring new insights into PC biology.
[0277] A panel of 41 SR biomarkers was applied to 12 prostate
biopsy samples from PC patients. Cytokeratin (a positive control)
and PSA (the standard PC biomarker) were measured in parallel. The
41 SR biomarkers included the 40 biomarkers described in FIG. 2,
and the Hsp 70 biomarker described in FIG. 3. The expression of the
SR biomarkers was analyzed using the methods described in Examples
1-4, except that the staining intensity was scored by an expert
pathologist using the traditional 0, 1, 2, 3 scoring procedure in
which 0 represents a baseline signal and scores 1 to 3 represent
3-fold increases over the baseline. The traditional scoring
procedure was highly reproducible (Spearman rank correlation
coefficient r=0.92, p<0.001 for duplicate scoring of 20
samples.) Antibodies against the 40 SR biomarkers are described in
FIG. 5. The anti-Hsp70 antibody was a mouse monoclonal IgG1 to
human hsp70 (SPA-816, Stressgen) diluted 1:100 for the individual
detection of Hsp70, and 1:4,000 for the combined SR biomarker
assay.
[0278] The SR biomarkers were scored separately in five
micro-anatomical areas of the prostate samples: (1) tumor with a
high malignancy potential (Gleason score.gtoreq.7), (2) high grade
intraepithelial neoplasia (PIN) considered to be the precursor of
malignant tumors, (3) tumor with a low malignancy potential
(Gleason score<7), (4) glandular atrophy, a non malignant
disease and (5) stroma which is the surrounding healthy prostate
tissue.
[0279] To rapidly survey stress levels in the samples and to
identify most stressed tissue areas, the combined SR biomarker
assay was used to measure the combined level of all 41 biomarkers.
FIG. 11 shows that the combined levels of SR biomarker levels were
15-25 fold higher in the high grade tumor and PIN, and 3-6 fold
higher in the low grade tumor and atrophy, than in the stroma. FIG.
11 also shows that PSA levels were lower in the high grade tumor
and PIN than in the low grade tumor. This result demonstrates that
the combined SR biomarker level positively correlates with the
tumor malignancy potential whereas the PSA level shows a negative
correlation, indicating that the SR biomarkers might be better
indicators of the clinical PC outcome than PSA.
[0280] To classify stress in the five micro-anatomical areas of PC,
SR biomarker profiles in the prostate were compared to SR biomarker
profiles in the reference skin samples, described in Examples 1 and
2. Hsp70 data were not included in the comparison because this
biomarker was not measured in the reference skin samples. All four
diseased PC areas (tumors, PIN and atrophy) were classified as
stressed whereas stroma was classified as normal. SR biomarker
profiles of the malignant areas (high grade tumor and PIN) were
similar, and distinct from profiles of the areas with low
malignancy potential (low grade tumor and atrophy). Classification
based on the 40 SR biomarker panel was similar to results obtained
using the minimal 5 SR biomarker panel described in Example 2.
[0281] To analyze the molecular mechanism of stress in PC, SR
pathway profiles were constructed as described in Example 3. As
shown in Table 8 below, pathways 3, 4 and 9 (underlined) were most
variable (the average pathway signature of PC-related stress.) This
result indicates that the dominant molecular mechanism of stress in
prostate cancer involves misfolded proteins (the trigger for
pathway 3), DNA mutations (the trigger for pathway 4) and increased
stimulation of immune responses (the trigger for pathway 9).
TABLE-US-00008 TABLE 8 Variability of SR Pathways in Prostate
Cancer Variability Index SR Pathway All cases Case 1 Case 2 1 Redox
1.79 1.54 2.05 2 Xenobiotics 1.31 1.23 1.40 3 Chaperoning 1.99 1.82
2.18 4 DNA repair 2.00 1.96 2.03 5 Cell adhesion 1.42 1.24 1.60 6
Cell growth 1.76 1.52 2.00 7 Cell death 1.43 1.33 1.53 8 NE
signaling 1.77 1.47 2.07 9 Immunity 1.82 1.55 2.08 10 Microbial
activation 1.60 1.50 1.70
[0282] A comparison between the SR pathway profile of prostate
cancer (3, 4, 9) and the SR pathway profile of diverse stressors in
reference skin samples (1, 3, 10 in Example 3) shows that the
molecular mechanism of stress has universal features (pathway 3 is
dominant in both situations) as well as disease-specific features
(pathways 4, 9 are most activated by PC and pathways 1, 10 by
diverse stressors.) Individual pathway signatures of PC were either
the same as the average PC signature (3, 4, 9 in All cases and in
Case 1, Table 7) or showed an individual difference in the
molecular mechanism of stress (3, 8, 9 in Case 2). Individual
differences in the molecular mechanisms of stress could be used for
personalized disease management such as a personalized medication
strategy.
[0283] In conclusion, this experiment demonstrates that the SR
profiling methods and the SR biomarker panel constructed using the
reference skin samples are directly applicable to prostate samples
and relevant to prostate cancer. The results of SR profiling of PC
samples provided new information into the molecular biology of PC.
This information has practical applications in predicting the
malignant potential of a prostate tumor, and in designing and
monitoring PC treatments.
Example 6
SR Profiling for the Analysis of Stress Related to Breast
Diseases
[0284] Five breast biopsy samples were obtained from two cases of
breast cancer (BC, invasive ductal carcinoma), one case of breast
disease due to a blood cancer caused by a viral infection (ATL,
HTLV-associated adult T cell leukemia) and two control cases with
benign breast changes (fibroid mastopathy). The expression of a
panel of 41 SR biomarkers was analyzed in the breast samples using
methods described in Example 5. EMA (epithelial membrane antigen),
a conventional biomarker expressed by both normal and diseased
mammary epithelial cells, was measured in parallel as a positive
control.
[0285] To rapidly survey stress levels in different areas of the
breast tissue, the combined level of the 41 SR biomarkers were
measured using the combined SR biomarker assay described in Example
4. The SR biomarker expression in the breast was consistently found
in the mammary epithelium. In the ATL sample, SR biomarkers were
also expressed in the large population of infiltrating leukemic T
cells that were found within the mammary epithelium. The combined
SR biomarker levels were 20-30 fold higher in the BC and ATL
samples than in the control breast sample. The EMA levels were high
in all samples.
[0286] To classify stress in the breast, SR profiles in the breast
samples were compared with the SR profiles in the reference skin
samples, using methods shown in Example 5. The BC and ATL samples
were classified as stressed, and the control breast as normal, by
both the 40 and the 5 SR biomarker panels. SR profiles of BC were
similar and distinct from the SR profile of ATL.
[0287] SR pathway profiling was applied to analyze the molecular
mechanism of stress in breast diseases, using the same methods as
in Example 5. The variability index for SR pathways is in Table 9
below. It was determined that the molecular mechanism of BC-related
stress involves misfolded proteins (the trigger for pathway 3),
increased free radicals (the trigger for pathway 1) and changes in
cell cycle and growth (the trigger for pathway 6). The mechanism of
ATL-related stress was found to involve increased activation of
comensal and pathogenic microorganisms (the trigger for pathway
10), increased levels of toxic molecules (the trigger for pathway
2) and increased free-radicals (the trigger for pathway 1).
TABLE-US-00009 TABLE 9 Variability of SR pathways in Breast
Diseases Variability Index SR Pathway Breast cancer ATL 1 Redox
0.89 1.13 2 Xenobiotics 0.60 1.19 3 Chaperoning 1.07 1.08 4 DNA
repair 0.87 1.11 5 Cell adhesion 0.81 0.90 6 Cell growth 0.88 1.07
7 Cell death 0.71 1.08 8 NE signaling 0.87 1.04 9 Immunity 0.84
1.08 10 Microbial activation 0.87 1.26
[0288] In conclusion, this experiment demonstrates that the SR
profiling methods and the SR biomarker panels constructed using the
reference skin samples, are directly applicable to breast samples
and relevant to breast cancer and the ATL breast disease. The
results provided new information into the biology of these
diseases, which might be useful for the development of new
diagnostic approaches to BC and ATL (no biomarkers currently
available), and in designing and monitoring treatment in these
diseases.
Example 7
The Use of SR Biomarkers for the Analysis of Stress Related to
NeuroAIDS
[0289] The recently introduced highly active antiretroviral therapy
(HAART) has not resolved problems of HIV-associated cognitive
disorders and dementia (HAD), collectively called neuroAIDS. At
present, neuroAIDS develops in 30-50% HIV-seropositive (HIV.sup.+)
patients, and represents a serious concern in clinical care for
HIV-infected populations. The current diagnostic methods for
neuroAIDS are based on measuring advanced clinical symptoms using
neurological and psychological tests. There are no molecular tests
for neuroAIDS, and no treatments other than HAART. There is an
urgent need to better understand the molecular mechanism of
neuroAIDS in order to develop new diagnostic and treatment
strategies.
[0290] Brain autopsy samples were obtained from three cases of
neuroAIDS (clinical dementia and post-mortem diagnosis of
encephalitis) and two control cases (dementia and encephalitis
free, age-matched AIDS). From each case, 3 anatomical areas of
brain were sampled: (1) frontal cortex, (2) basal ganglia and (3)
cerebellum. The expression of a panel of 41 SR biomarkers was
analyzed in the brain samples using methods described in Example 5.
The control samples were used to define baseline expression levels.
HIV infection was detected using a mouse monoclonal IgG1 to
recombinant HUVp24gag protein (Kal-1, Dako). Microglia/macrophages
(positive control) were detected using a mouse monoclonal IgG1 to
human CD 68 (KP-1, Dako).
[0291] Numerous HIV infected macrophages/microglial cells were
detected in frontal cortex and basal ganglia, but not in
cerebellum, in all three neuroAIDS samples. No HIV infected cells
were found in control samples. A similar pattern of HIV infection
in neuroAIDS was reported previously.
[0292] To rapidly survey stress levels, the combined SR biomarker
assay described in Example 4 was used to measure the combined
levels of all 41 SR biomarkers. SR biomarker expression was found
in multiple cell types: neurons, glia, microglia/macrophages and in
the neuro-epithelium. The neuroAIDS samples had 10-80 fold higher
levels of the combined SR biomarkers than the control samples. The
levels were highest in frontal cortex and basal ganglia indicating
that stress in these anatomical areas was more severe than in
cerebellum. These results show that cellular stress is widespread
in the brain of neuroAIDS patients and is present in infected as
well as uninfected cell types and anatomical areas.
[0293] To gain a detailed insight into the distribution of SR
biomarker expression in specific micro-anatomical areas (white
matter, gray matter) and specific cell types (macrophages/microglia
in white matter and neurons/glia in grey matter), computerized
image analysis was performed as described in Example 1. Results for
a representative SR biomarker (beta-endorphin) showed that the
biomarker level in frontal cortex was 75-fold higher in neuroAIDS
than in controls. The increased SR biomarker was preferentially
found in white matter (96-fold increase) as compared to grey matter
(7-fold increase). Within white matter, the SR biomarker was
localized to perivascular inflammatory cell clusters. Within grey
matter, the SR biomarker was localized to neurons and glia.
[0294] To classify stress in neuroAIDS, SR profiles in the brain
samples were compared with the SR profiles in the reference skin
samples, using methods shown in Example 5. The neuroAIDS samples
were classified as stressed, and the control samples as normal, by
both the 40 and the 5 SR biomarker panels. SR profiles of frontal
cortex and basal ganglia in all three neuroAIDS cases were similar
and distinct from SR profiles of neuroAIDS cerebellum.
[0295] SR pathway profiling analysis was applied to analyze the
molecular mechanism of stress using the same methods as in Example
5. The variability of SR pathways is in Table 10 below.
TABLE-US-00010 TABLE 10 Variability of SR Pathways in NeuroAIDS SR
Pathway Variability Index 1 Redox 0.96 2 Xenobiotics 0.99 3
Chaperoning 0.96 4 DNA repair 0.88 5 Cell adhesion 0.83 6 Cell
growth 0.88 7 Cell death 0.91 8 NE signaling 0.82 9 Immunity 0.83
10 Microbial activation 0.91
[0296] It was found that pathways 1, 2 and 3 were most activated
indicating that the molecular mechanism of neuroAIDS-related stress
involves increased free radicals (the trigger for pathway 1),
increased levels of toxic molecules (the trigger for pathway 2) and
misfolded proteins (the trigger for pathway 3). SR pathway
variability was higher in frontal cortex and basal ganglia
providing further evidence that cellular stress was more severe in
these brain areas than in cerebellum.
[0297] In conclusion, it was demonstrated that the SR profiling
methods and the SR biomarker panels constructed using the reference
skin samples, are directly applicable to brain samples and relevant
to neuroAIDS. These results provide new information into the
cellular and molecular mechanisms of neuroAIDS, which might be
useful for the development of new diagnostic approaches to
neuroAIDS (no laboratory test is currently available), and in
designing and monitoring neuroAIDS treatment.
Example 8
SR Biomarker Assays for Saliva-Based Analysis of Psychological
Trauma
[0298] Psychological trauma is common and can cause debilitating
health disorders such as the post-traumatic stress disorder (PTSD).
Current diagnostic methods for PTSD are based on neurological and
psychological tests that are laborious and not suitable for early
diagnostics of PTSD. There is no laboratory test for PTSD.
[0299] Longitudinal saliva samples (about 0.1 ml, 20 time points)
were obtained from four healthy volunteers by passive drooling into
a test tube. Another volunteer was sampled in the same way before
and during a two-month-long psychological trauma related to a
grieving process (8 time points). The saliva samples were used to
prepare alcohol-fixed cell smears on histology slides. The saliva
samples were analyzed using the combined SR biomarker assay
described in Example 4. The samples obtained from the healthy
volunteers were used to define baseline scores. Cytokeratin
(positive control) was analyzed in parallel.
[0300] The combined SR biomarker scores in all control samples were
near baseline and showed a low fluctuation indicating that the
baseline was stable. The other volunteer also had baseline scores
before the psychological trauma. The scores in that volunteer
started to rise after the psychological trauma (about 10-fold
increase), reached the highest levels in about 2 weeks after the
trauma (about 100-fold increase) and declined to near baseline
level on in a month and half.
[0301] In conclusion, this Example documents that stress response
profiling is suitable for saliva samples and relevant to stress
related to psychological trauma, and the results are useful for
monitoring stress levels and the time course of stress.
Example 9
SR Profiling for the Analysis of Stress in Massaged and Diseased
Skin
[0302] Skin massage has been historically used to reduce stress.
Massaging is frequently performed but the underlying molecular
mechanisms, including the stress-reducing effects, are little
understood. To analyze the effects of massage, SR biomarkers were
assayed in normal skin before and after massage, and in diseased
skin that served as a positive control for stress.
[0303] Skin biopsy samples were obtained from 7 subjects: 4
controls (healthy volunteers), one healthy volunteer before and
after a professional therapeutic skin massage, and two psoriasis
patients. The expression of a panel of 41 SR biomarkers was
analyzed in the skin samples using methods described in Example
5.
[0304] The combined levels of the 41 biomarkers, measured using the
combined SR biomarker assay, were 13-fold higher in psoriasis than
in healthy skin, and 3-fold higher in the massaged skin.
[0305] The massage decreased the expression of 22 SR biomarkers and
increased the expression of 7 biomarkers indicating that the
dominant effect of the massage was a downregulation of stress
responses. This effect was opposite to the upregulation of diverse
stressors (see Examples 1-8.)
[0306] The variability index for the SR pathways is in Table 11
below:
TABLE-US-00011 TABLE 11 Variability of SR Pathways in Massage and
Psoriasis Variability index SR Pathway Massage Psoriasis 1 Redox
0.579 0.898 2 Xenobiotics 0.497 0.965 3 Chaperoning 0.189 1.029 4
DNA repair 2.085 0.847 5 Cell adhesion 1.052 1.003 6 Cell growth
0.321 0.968 7 Cell death 0.461 0.822 8 NE signaling 0.519 0.902 9
Immunity 0.581 0.999 10 Microbial activation 1.165 0.644
[0307] All pathways were downregulated by the massage. The most
down-regulated pathways were 4, 5 and 10 (DNA repair, cellular
adhesion and motility, microbial activation.) In contrast,
psoriasis-related stress upregulated SR pathway activity, in
particular pathways 3, 5 and 9 indicating increased levels of
misfolded proteins (the trigger for pathway 3), changes in cellular
adhesion and motility (the trigger for pathway 5) and increased
stimulation of immune responses (the trigger for pathway 9).
[0308] In conclusion, this experiment demonstrated that SR
profiling and the SR biomarker panels constructed using the
reference skin samples, are relevant to the analysis of stress
modulation by stress-relieving treatments such as therapeutic skin
massage. The results have practical applications for the
development of noninvasive tests for monitoring of the effects of
stress-relieving treatments including acupuncture and other
modalities of complementary and alternative medicine.
Example 10
SR Profiling and Combined SR Biomarker Assay to Detect Disease in
Elephants
[0309] Wild elephants show increased incidence of disease outbreaks
and aggressive behaviors suggesting an incipient health crisis.
Current methods for assessing the health of a population are based
on estimated trends in abundance, mortality, and reproductive
rates. These methods are sometimes too slow to provide early
warnings of compromised health in populations with long generation
times, such as elephants.
[0310] SR biomarkers were applied to measure stress is elephants
with known health status to evaluate whether stress measurements
could be used to predict elephant health. Skin biopsies were
obtained from two captive African elephants with clinically
diagnosed gastrointestinal infection and from four healthy wild
elephants from the Addo National Park in South Africa. The
expression of a panel of 41 SR biomarkers was analyzed using
methods described in Example 5.
[0311] To rapidly survey stress levels, the combined level of the
41 SR biomarkers were measured using the combined SR biomarker
assay described in Example 4. The SR biomarker expression was
consistently found in the epidermis of the elephant skin, as in the
reference skin samples (Examples 1-4). The combined SR biomarker
levels were 5 to 7-fold higher in the diseased samples than in the
control.
[0312] To classify stress, SR profiles in elephants were compared
to the reference SR profiles in the reference skin samples, using
methods described in Example 5. The diseased elephants were
classified as stressed and the healthy elephants as normal by both
the 40 and the 5 SR biomarker panels.
[0313] SR profiling as described in Example 3 was applied to
analyze the molecular mechanism of stress in elephants. The
variability of SR pathways is in Table 12 below.
TABLE-US-00012 TABLE 12 Variability of SR Pathways in Elephant
Disease SR pathway Variability Index 1 Redox 0.677 2 Xenobiotics
0.673 3 Chaperoning 0.817 4 DNA repair 0.706 5 Cell adhesion 0.466
6 Cell growth 0.532 7 Cell death 0.511 8 NE signaling 0.547 9
Immunity 0.566 10 Microbial activation 0.585
[0314] Pathways 3 and 4 were most activated in the diseased
elephants indicating that their molecular mechanism of stress
mostly involved misfolded proteins (the trigger for pathway 3) and
DNA mutations (the trigger for pathway 4).
[0315] In conclusion, it was demonstrated that SR profiling and the
SR biomarker panels constructed using the reference skin samples,
are directly applicable to elephant skin samples and relevant to
elephant diseases. The results show that SR biomarker profiling is
useful for predicting health in captive and wild elephants and may
provide a starting point for practical applications in elephant
conservation.
Example 11
SR Profiling for the Analysis of Stress in Cultured Human Cells
[0316] In vitro toxicity testing reveals the effects of toxic
substances on cultured bacterial or mammalian cells. It is employed
primarily to identify potentially hazardous chemical or biological
agents and/or to confirm the lack of certain toxic properties in
the early stages of the development of potentially useful new
substances such as therapeutic drugs, agricultural chemicals and
direct food additives. In vitro toxicity testing is a useful, time
and cost-effective supplement to toxicology studies in living
animals. In vitro assays for xenobiotic toxicity are recently
carefully considered by key government agencies (e.g. the
Environmental Protection Agency (EPA), the National Institute of
Environmental Health Sciences/National Toxicity Program
(NIEHS/NTP), and the Food and Drug Administration (FDA)) in order
to reduce the use of animals in research, and to advance
mechanistic understanding of toxicant activities.
[0317] There is a particular interest in toxicity testing based on
human cells that might define human-specific toxic effects. Current
methods include the detection of changes in cellular morphology
using electron microscopy and image analysis, cell death
(apoptosis) assays and cellular transformation (cancer) assays.
These assays are laborious and do not provide early warnings of the
initial molecular damage in the cell that may be an important
indicator of compromised cellular health, before the emergence of
observable changes in cellular morphology or the onset of cellular
transformation or apoptosis. To systematically monitor early
molecular changes in cultured cells exposed to chemical or
biological agents, the 41 SR biomarker panel was queried using
methods described in Example 5.
[0318] Samples were primary cultures of human epithelial cells from
gut and tonsils cultured on multichamber microscopy slides. Cells
were treated with chemical stressors including alloxan (oxidizing
agent and DNA mutagen) or with physical stressors including heat
shock and uv light, or with biological stressors including the
infection with disease-causing viruses (HTLV-1, HIV) or bacteria
(Streptococcus pyogenes). Control cells were cultured for the same
time as treated cells, without any treatments. At the end of
treatments, adherent cells were fixed in situ using 10% normal
buffered formalin. The combined levels of the 41 SR biomarkers were
measured using the combined SR biomarker assay. The combined levels
were increased 3 to 30 fold by the treatments.
[0319] In conclusion, it was demonstrated that the SR profiling and
the SR biomarker panels constructed using the reference skin
samples, are directly applicable to samples of cultured human cells
and relevant to diverse physical, chemical and biological
stressors. The results have practical applications in toxicity
testing in vitro.
Example 12
SR-Based Noninvasive Rapid Health Test (Humans)
[0320] Concept: The combined SR biomarker assay described in
Example 4 detects systemic increase in SR expression that indicates
increased chronic physiological stress, and predicts increased risk
of disease. minimally-invasive test samples such as microliters of
biofluids (saliva, finger-prick blood, sweat, urine) or exhaled
breath.
[0321] Commercialization Ideas:
[0322] (1) A test kit for the use at home or in doctor's office
including: A small, hand-held device similar to a digital
thermometer. The device includes a disposable module for sample
uptake and reagent storage (refills sold separately), and a
re-usable module for signal detection and result display that may
involve optical and electronic components. No training required for
sampling and test operation. Real-time results (1-3 minutes).
Simple readout of results, e.g. percent above baseline or an
artificially color-coded scale from green to red.
[0323] OR
[0324] A test strip. One end is briefly put to mouth to wick up
saliva. The result (a combined SR biomarker level) is indicated by
a color change in the result area of the strip (litmus test--like).
Disposable.
[0325] OR
[0326] A sampling strip (a plastic microscopy slide), a collection
cup, a plastic spatula, a small pouch with fixative (alcohol),
instructions for making and fixing a saliva smear, a mailing
envelope/packaging addressed to GAIA. Fixed slides can be send by
regular mail (SR biomarkers are stable). GAIA processes the slide
and sends results back via self-addressed envelope and/or the
results are posted on GAIA website (via personalized access
code).
[0327] AND
[0328] Software, or a web access to GAIA website, with regularly
updated information on health promoting and health-risk factors
that can be detected by the SR test, health tips, and links to
health products and services (paid ads).
[0329] (2) A test kit for histology labs including: Saliva
collection cup and instruction for saliva smears on microscopy
slides. Alternatively, saliva smear could be prepared by a doctor's
assistant during a medical exam, fixed with an alcohol spray (like
PAP smear) and send to a central lab. Primary anti-SR antibodies
(newly made as highly compatible chicken IgG, easier to use than
the commercial panel described in the Nature paper); recommended
optimal concentration of the primary antibodies to make the
combined SR reagent for human saliva. Microscopic slides with
positive and negative controls (saliva smears with normal and
stressed cells). Staining instructions, result interpretation,
website link to GAIA for technical assistance.
[0330] Applications
[0331] Consumer diagnostics: Self-administered health test for home
use. Personalized monitoring of health risk factors such as diet,
exercise, health supplements, urban pollution, pesticides, sun
exposure, geographical location, work environment, relationships,
etc.
[0332] POC diagnostics: Health test administered in doctor's office
during routine medical checkups (along with routine vital
signs).
[0333] Personalized medicine: self-administered stress response
test to gauge a patient's reaction to a medical drug (or device).
Early identification of adverse effects. Complementary/alternative
medicine (CAM). Currently, there is no objective test to measure
effects of CAM treatments such as acupuncture, cold laser,
homeopathic/herbal supplements, physical therapy, massage,
meditation. At present, the outcome of CAM treatments is monitored
using self-reported pain, stress, energy levels at each office
visit. Objective monitoring is challenging because CAM modalities
combine multiple factors with physical, chemical, biological and
psychological effects on human physiology. SR biomarkers are
optimally suited to monitor CAM effects because they were developed
for detecting complex combinations of diverse stressors. SR
profiling were shown to detect effects of massage (Example 9). SR
based test could be used to for initial assessment of patient's
chronic stress level, and to monitor/guide CAM treatments.
[0334] Mental Health Diagnostics and Treatment Monitoring.
[0335] Currently, mental health diagnostics is largely based on a
battery of neuropsychological tests that cannot provide early,
preclinical signatures of mental disorders, Mental disorders are
associated with increased levels of chronic physiological stress
that can be objectively measured by SR profiling or the combined SR
biomarker assay. SR-based classification of demented AIDS patients
(Example 7) indicates that saliva-based SR profiling could be used
for early detection of neurodegenerative disorders, before the
emergence of neuropsychological cognitive deficits. Combined SR
biomarker scores detected increased cellular stress in saliva
during psychological stress (Examples 8 and 18). This result
indicates that the combined SR test could be used to measure
chronic stress levels as a part of the patient's initial mental
health assessment, for early detection of post-traumatic stress
disorders (PTSD), and to monitor/guide treatments (drugs,
counseling). The SR biomarker test could be particularly useful for
PTSD screening in people with high risk (soldiers returning from
deployment, battered women).
[0336] Dental health.
[0337] SR profiling of saliva/dental plaque is applicable for early
detection of gum disease, a serious disorder linked to increased
risk of diabetes and cardiovascular disease. Currently, periodontal
disease is diagnosed by dentist based on clinical symptoms, and a
molecular test for early detection or prediction is not available.
Rapid SR profiling could be delivered in dentist's office during
routine oral exams, or could be made into self-administered
periodontal test for home use. Adding new SR biomarkers for the
microbial biofilms pathway might improve the sensitivity of gum
disease detection. The SR biomarker test device might use a dental
floss for the collection of saliva plus dental plaque and possibly
also to directly indicate test results.
[0338] Field diagnostics: Health test administered by non-medical
personnel during emergency calls or mass health crises due to
natural, industrial and terror disasters civilian (e.g. after
Hurricane Katrina).
[0339] Occupational safety: health biomonitoring in environments
with high levels of physiological stressors (heat, radiation,
noise, gravity, oxygen, toxins, pathogens, psychological stress)
such as haz-mat personnel, fighter pilots, military and police,
astronauts.
[0340] Environmental safety. Monitoring health outcomes in people
with chronic exposures to industrial chemicals used in industrial
and agricultural processes, urban pollution etc. SR profiling could
be particularly useful for novel products with unknown biological
effects such as engineered nanoparticles.
Example 13
SR-Based Rapid Health Test for Pets and Farm Animals
[0341] SR biomarker assays, devices and software as described in
Example 12, adapted for animals. SR biomarkers are applicable to
all vertebrate animals, invertebrates and fungi.
[0342] Pets, domesticated farm animals (cattle, chickens),
wild-harvest animals (fish, clams, crabs, oysters, shrimp,
lobsters) are exposed to numerous stressors related to habitat,
handling, diet and pathogens. Recent global climate changes
affected many wild habitats, for example a rise in coastal water
temperature in New England is considered a prime factor in the
collapse of local lobster fishery.
[0343] Test samples: Saliva, exhaled breath and urine could be used
for mammals (pets, cattle, pigs), skin biopsy for birds (chickens).
For other species, suitable sampling procedures would be developed
for particular types of animals. Consumer diagnostics: health test
administered by pet owners or farmers. POC diagnostics: Health test
administered in vet's office.
Example 14
SR-Based Rapid Health Test for House and Farm Plants
[0344] The combined SR biomarker assay, devices and software as
described in Example 12, adapted for plants. SR biomarkers are
applicable to algae and plants as described above. Test samples:
suitable sampling procedures would be developed for particular
types of organisms. For example, plant sample could be a leaf, or a
soil sample. New SR biomarkers for microbial biofilms would be
included to monitor health of symbiotic microorganisms. Algae can
serve as sentinel organisms for environmental stress in aquatic
ecosystems. Consumer diagnostics: health test administered by house
plant owners or farmers. Service via mail-in samples. Service
provided via designated nurseries.
Example 15
SR Biomarker Test for Early Detection of Disease
[0345] (1) Cervical Cancer
[0346] Background: Currently, cervical smears are collected during
routine physical exams (PAP), stained with a non-specific PAP stain
and read by a histologist who is looking for epithelial cells with
abnormal morphology indicating a pathological process in the
cervix. There is no molecular biomarker to identify early signs of
pathology in cervical cells (before the onset of morphological
changes).
[0347] Concept: The combined SR biomarker assay was shown to detect
early signs of pathology in epithelial cells of different origin
(skin, breast, prostate, saliva) and is likely to identify abnormal
cervical epithelial cells.
[0348] Commercialization: Two slides could be prepared during a
routine PAP test in a doctor's office. One slide would be stained
with PAP stain and read as usual. The other slide would be stained
to reveal combined SR biomarkers using a SR kit described in
Example 12. A comparative study would determine whether combined SR
staining improved the PAP test sensitivity and reliability, and
whether the combined SR stain could replace the PAP stain.
Potentially, combined SR is more sensitive than the PAP stain
because it can detect cellular stress earlier than the PAP which
helps to discern a morphological change. Additionally, the combined
SR staining result (red color) is more easy to read than the PAP
stain (PAP is a contrast stain that helps to notice an abnormal
cell morphology).
[0349] (2) Prostate Cancer
[0350] Background: Currently, the PSA protein in blood is used as
biomarker for prostate cancer (PC). PSA is elevated not only in PC
but also in nonmalignant prostate/urinary tract inflammation, so
there is a need for better PC biomarkers, in particular biomarkers
for early signs of prostate cancer, and for identification of
patients with metastatic PC.
[0351] Concept: Combined SR biomarkers strongly labeled PC tumor
cells and other abnormal cells in diseased prostate, and better
classified PC than PSA (Example 5). Prostate epithelial cells (the
substrate for PC) are shed into semen in healthy men and PC
patients. Semen might also contain metastatic PC cells. Combined SR
staining of semen smears might reveal the presence of abnormal
prostate epithelial cells in general (tumor, PIN, BPH, atrophy).
Positive cases might be analyzed in detail, using individual SR
biomarkers in order to discriminate between cancer and
non-malignant cells, and to identify metastatic cells. In addition
to the original 41 SR biomarkers (Hsp70 was added to the panel for
the PC study) new SR biomarkers could be added including OCT and
nucleostemin (somatic stem cell proliferation) to improve
classification of metastatic cells. Identification of metastatic
PC: Unlike normal somatic cells, metastatic cells are likely to
have highly upregulated stress responses and therefore strongly
increased SR expression. Metastatic cells need high stress
responses because they undergo multiple adaptations. First, during
tumor growth, adaptations to oxygen and glucose starvation, loss of
cellular adhesion, altered neuro-endocrine signaling, increased
oxidative stress, variable temperature. After departure from tumor,
metastatic cells have to adapt to new stressors during migration
though blood and invasion of other tissue types, e.g. high oxygen
and glucose, novel cellular interactions and neuro-endocrine
signals. Metastatic PC cells might be present not only in semen but
also in saliva (or exhaled breath). Therefore, saliva
(breath)-based SR test could be potentially used to classify
metastatic PC. Personalized diagnostics: (1) SR profiling of
prostate tissue removed during surgery (tumor or adjacent tissues)
might help to identify types of molecular damage and cellular
stress specific for the patient. This information could be used to
guide chemotherapy. For example, anti-oxidant chemotherapy might be
used if redox activation was preferentially activated in the
diseased prostate tissue. (2) SR profiling of semen/saliva could be
used to monitor effects of radio/chemo therapy SPR could be also
used to monitor effects of follow-up therapies such as physical
therapy of psychological counseling, for which there is currently
no objective test (see prophetic Example 1, CAM and mental
health).
[0352] Commercialization: Semen smears would be collected in
doctor's office (alcohol fixed microscopy slide similar to cervical
PAP slide) during routine physical exam. The semen smear would be
stained with a combined SR reagent using a SR kit described in
Example 12. Combined SR biomarker staining is likely to identify
early signatures of prostate abnormalities and PC, before clinical
symptoms. In case of a positive results with the combined SR
biomarker test, or in patients where PC is suspected based on
clinical symptoms, a larger semen sample would be collected (along
with blood for PSA test) in order to stain multiple slides with
individual SR biomarkers, using a SR histology kit (reagents,
software). SR staining is likely to reveal more information about
the nature of abnormal prostate cells than the PSA blood test. As
described above, SPR staining could be also used to examine
surgical prostate samples and guide the choice of drugs for
chemotherapy, and to evaluate the effect of therapy. It is
important that SR can be applied to tissues surrounding the tumor
because the pathologist responsible for PC diagnostics will want
all the tumor-containing tissue.
[0353] (3) Other Diseases.
[0354] Background: Multiple diseases are known to involve increased
cellular stress in the diseased tissue as well as in distant
tissues and peripheral body fluids such as blood and saliva. There
is a growing evidence of this process in different types of cancer,
AIDS, metabolic diseases such as diabetes, autoimmune diseases,
neurodegenerative diseases.
[0355] Concept: Combined SR biomarker assay of saliva (or exhaled
breath) could be used for predicting disease risk, or early
diagnosis of these diseases, before the onset of clinical symptoms.
In positive cases, additional staining with individual SR
biomarkers might provide disease-specific signatures and single-out
aggressive outcomes (e.g. metastatic cancer or a progressive
neurodegenerative disease).
[0356] Commercialization: Combined SR biomarker test of saliva
could be administered during routine physical exams or using a
self-administered home test (see). Individual SR biomarkers could
be analyzed using SR kit in a histology lab as described
previously. Alternatively, a new biosensor device could be used
such as described above.
Example 16
Early Disease Detection In Vivo Using SR-Guided Imaging
[0357] Concept: Increased cellular stress in a tissue provides an
early warning of a disease process. Increased cellular stress can
be detected using SR biomarkers. Imaging technique such as MRI
could be used to detect elevated SR in vivo, non-invasively. A
SR-binding molecule (antibody or aptamer) could be conjugated to
the surface of an MRI contrast agent in order to preferentially
guide the MRI agent to tissues with high SR expression. Conjugates
with combined SR biomarkers could be used for general screening.
Individual SR biomarkers (or pathway-specific) could be used in
positive cases for differential diagnosis. Other types of
biomarkers could be used in conjunction with SR biomarkers to
improve diagnostic accuracy (e.g. cell type specific biomarkers,
pathogen biomarkers).
Example 17
Global Stress Watch
[0358] Concept: Climate change and human activities impact the
health of ecosystems. It is important to identify ecosystems and
species that are most at risk so that they can be targeted for
protection. SR biomarkers can detect the impact of a various
stressors, single or combined, including unknown stressors. SR
biomarkers are also applicable to all types of organisms, which is
advantageous for ecosystem-wide analysis. (1) Increased stress
responses detected by profiling of combined SR biomarkers could be
used to identify hot spots of environmental stress, predict the
health of ecosystems and out populations at risk of collapse. (2)
Correlation studies could be used to link SR signatures with
potential health threats (e.g. tuna fishery for spotted dolphins).
This information could be used to guide improved management of the
stressed species/ecosystem. (3) SR profiling could be used to
monitoring the effect of stress-reducing measures.
Example 18
SR Profiling of Saliva During Grieving and Disease
[0359] Grieving is known to trigger systemic physiological stress
manifested as nausea, pain, anxiety and fatigue. Although grieving
is common, the molecular mechanism of grieving stress is little
understood. A little is also known about saliva stress responses
during disease, and whether saliva-borne biomarkers could be
developed for disease diagnostics.
[0360] Whole saliva specimens (about 0.1 ml) were obtained from
four healthy volunteers at multiple times by passive drooling into
a test tube. Two of the volunteers were also sampled when they had
a medically diagnosed herpes virus infection or a streptococcal
throat infection. One volunteer was also sampled during a two
month-long grieving process (Days 3, 5, 8, 11, 13, 16, 18, 45). The
saliva specimens were used to prepare cell smears on histology
slides. Fifteen microliters of unprocessed whole saliva was smeared
on each slide, air dried for 10 minutes at room temperature, fixed
in normal buffered formalin and ethanol. The slides were used for
immunocytochemical staining with pooled antibodies against 41 SR
biomarkers as in the combined SR assay described in Example 5.
Cytokeratin, a ubiquitous epithelial protein, was detected as a
positive control.
[0361] Baseline SR expression was found in all specimens from the
healthy volunteers. Herpes infection was associated with about 5%
increase in SR-positive cells in saliva. The positive cells were
monocytes and microbial cells. The strep throat infection was
associated with about 0.1% increase in SR-positive cells in saliva.
The positive cells were monocytes and microbial cells. The grieving
had the most pronounced effect on SR expression in salivary cells.
On Day 3, about 10% salivary microbial cells (yeast, bacteria) and
about 1% salivary mammalian cells (epithelial cells, monocytes,
lymphocytes and granulocytes) were SR positive. Many positive
microbial cells were adhering to, or internalized by, epithelial
cells. On Days 5, 8 and 11, about 50% microbial and 1-5% mammalian
cells had increased SR biomarkers, and microbial-epithelial
interactions were extensive. On Days 13, 16 and 18, all microbial
cells and about 50% mammalian cells were SR positive. On Day 45,
less than 1% salivary cells were positive. Cytokeratin expression
was consistent and unchanged in all diseased and control specimens
indicating that the staining results were not affected by
histological conditions of the saliva cells, or the staining
process.
[0362] In conclusion, SR profiling of saliva cells was found
applicable for objective indexing of stress responses in healthy
people, and during physiological stress due to disease or grieving.
During disease and grieving, stress responses in microbial cells
were earlier and larger than in mammalian cells, indicating that
microbial cells might be the first cells in saliva that sensed the
systemic physiological stress. Extensive interactions between
SR-positive microbial cells and SR-negative epithelial cells were
followed by a increase in SR-positive epithelial cells, suggesting
that microbial cells might cross-talk with epithelial cells, and
transduce molecular stress signals that trigger stress responses in
epithelial cells and other mammalian cells in saliva.
[0363] This example illustrates that saliva-based SR profiling
provides a new, noninvasive method for health status screening,
disease diagnostics and monitoring of psychological stress. SR
bioassays can detect SR biomarkers in the liquid fraction of
saliva, or in homogenized saliva preparations that contain
solubilized salivary cells. Exhaled breath contains microdroplets
of saliva, and can be used as an alternative sample for SR
profiling assays.
Example 19
Stress-Induced Plasmid in Mammalian Cells
[0364] A DNA sequence ("USED") has been identified that is
amplified during mammalian stress responses. A single copy of a 3
kb USED sequence is integrated in the genomic DNA in different
types of mammalian cells (epithelial cells, splenocytes of human,
monkey, mouse origin). Within 1-2 hrs of stress exposure (heat
shock, starvation/serum stimulation, drug selection, LPS
stimulation), multiple copies of USED are present in the cytoplasm.
This cytoplasmic USED is a circular DNA, 3 kb or larger
(recombination with larger circular DNA species?) during stress
responses: heat shock, serum induction, LPS stimulation. USED may
be linked to extrachromosomal genetic mechanisms in mammalian
cells. These mechanisms are activated during adaptive stress
responses, for example extrachromosomal mammalian gene
amplification and gene repair under drug pressure, circular DNA
species associated with embryonic development and T cell receptor
recombinations.
[0365] With respect to ranges of values, the invention encompasses
each intervening value between the upper and lower limits of the
range to at least a tenth of the lower limit's unit, unless the
context clearly indicates otherwise. Moreover, the invention
encompasses any other stated intervening values and ranges
including either or both of the upper and lower limits of the
range, unless specifically excluded from the stated range.
[0366] Unless defined otherwise, the meanings of all technical and
scientific terms used herein are those commonly understood by one
of ordinary skill in the art to which this invention belongs. One
of ordinary skill in the art will also appreciate that any methods
and materials similar or equivalent to those described herein can
also be used to practice or test this invention.
[0367] The publications and patents discussed herein are provided
solely for their disclosure prior to the filing date of the present
application. Nothing herein is to be construed as an admission that
the present invention is not entitled to antedate such publication
by virtue of prior invention. Further the dates of publication
provided may be different from the actual publication dates which
may need to be independently confirmed.
[0368] All the publications cited are incorporated herein by
reference in their entireties, including all published patents,
patent applications, literature references, as well as those
publications that have been incorporated in those published
documents. However, to the extent that any publication incorporated
herein by reference refers to information to be published,
applicants do not admit that any such information published after
the filing date of this application to be prior art.
[0369] As used in this specification and in the appended claims,
the singular forms include the plural forms. For example the terms
"a," "an," and "the" include plural references unless the content
clearly dictates otherwise. Additionally, the term "at least"
preceding a series of elements is to be understood as referring to
every element in the series. The inventions illustratively
described herein can suitably be practiced in the absence of any
element or elements, limitation or limitations, not specifically
disclosed herein. Thus, for example, the terms "comprising,"
"including," "containing," etc. shall be read expansively and
without limitation. Additionally, the terms and expressions
employed herein have been used as terms of description and not of
limitation, and there is no intention in the use of such terms and
expressions of excluding any equivalents of the future shown and
described or any portion thereof, and it is recognized that various
modifications are possible within the scope of the invention
claimed.
[0370] Thus, it should be understood that although the present
invention has been specifically disclosed by preferred embodiments
and optional features, modification and variation of the inventions
herein disclosed can be resorted by those skilled in the art, and
that such modifications and variations are considered to be within
the scope of the inventions disclosed herein. The inventions have
been described broadly and generically herein. Each of the narrower
species and subgeneric groupings falling within the scope of the
generic disclosure also form part of these inventions. This
includes the generic description of each invention with a proviso
or negative limitation removing any subject matter from the genus,
regardless of whether or not the excised materials specifically
resided therein. In addition, where features or aspects of an
invention are described in terms of the Markush group, those
schooled in the art will recognize that the invention is also
thereby described in terms of any individual member or subgroup of
members of the Markush group.
[0371] It is also to be understood that the above description is
intended to be illustrative and not restrictive. Many embodiments
will be apparent to those of in the art upon reviewing the above
description. The scope of the invention should therefore, be
determined not with reference to the above description, but should
instead be determined with reference to the appended claims, along
with the full scope of equivalents to which such claims are
entitled. Those skilled in the art will recognize, or will be able
to ascertain using no more than routine experimentation, many
equivalents to the specific embodiments of the invention described.
Such equivalents are intended to be encompassed by the following
claims.
* * * * *