U.S. patent application number 13/332071 was filed with the patent office on 2012-07-05 for biomarkers and uses thereof in prognosis and treatment strategies for right-side colon cancer disease and left-side colon cancer disease.
Invention is credited to Steven Buechler, Amanda Hummon.
Application Number | 20120172244 13/332071 |
Document ID | / |
Family ID | 46381277 |
Filed Date | 2012-07-05 |
United States Patent
Application |
20120172244 |
Kind Code |
A1 |
Buechler; Steven ; et
al. |
July 5, 2012 |
BIOMARKERS AND USES THEREOF IN PROGNOSIS AND TREATMENT STRATEGIES
FOR RIGHT-SIDE COLON CANCER DISEASE AND LEFT-SIDE COLON CANCER
DISEASE
Abstract
Genetic biomarkers for left side colon cancer (LCC) (such as
expression levels of an RNA transcript or expression product of
NOX4, MMP3, or a combination) and right side colon cancer (RCC)
(such as expression levels of an RNA transcript or expression
product of CDCX2, FAM69A, or a combination), are disclosed. Methods
for using the biomarkers in providing a prognosis of relapse-free
survival probability in patients having LCC or RCC are also
presented. Prognostic panels using gene expression values of the
biomarkers are also presented. Computer implemented methods
employing the biomarkers, and as well as for determining
relapse-free survival probability in a patient having RCC or LCC
are provided. A genetic method for classifying a colon cancer
tissue as a RCC or as a LCC is also disclosed.
Inventors: |
Buechler; Steven; (Granger,
IN) ; Hummon; Amanda; (Granger, IN) |
Family ID: |
46381277 |
Appl. No.: |
13/332071 |
Filed: |
December 20, 2011 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
61459864 |
Dec 20, 2010 |
|
|
|
61462592 |
Feb 4, 2011 |
|
|
|
Current U.S.
Class: |
506/9 ; 435/189;
435/219; 435/375; 506/16; 536/23.2; 702/19 |
Current CPC
Class: |
C12Q 2600/118 20130101;
C12Q 1/6886 20130101; C12Q 2600/106 20130101; C12N 5/0693 20130101;
G01N 33/57484 20130101; G01N 33/57419 20130101; C12Q 2600/158
20130101; C12Q 1/686 20130101; G01N 2800/54 20130101 |
Class at
Publication: |
506/9 ; 435/189;
435/219; 536/23.2; 506/16; 435/375; 702/19 |
International
Class: |
C40B 30/04 20060101
C40B030/04; C12N 9/50 20060101 C12N009/50; G06F 17/18 20060101
G06F017/18; C40B 40/06 20060101 C40B040/06; C12N 5/09 20100101
C12N005/09; C12N 9/02 20060101 C12N009/02; C07H 21/02 20060101
C07H021/02 |
Claims
1. A genetic biomarker for left side colon cancer (LCC) in a
patient, said biomarker comprising an expression level of an RNA
transcript or expression product of NOX4, MMP3, or a combination of
NOX4 and MMP3.
2. The genetic biomarker of claim 1 wherein a relatively high
expression level of an RNA transcript or expression product of NOX4
from a tissue harvested from a left colon tumor tissue sample is
predictive of a decreased 5-year relapse-free survival probability
for colon cancer.
3. The genetic biomarker of claim 1 wherein a relatively low
expression level of an RNA transcript or expression product of NOX4
from a tissue harvested from a left colon tumor tissue sample is
predictive of an increased 5-year relapse-free survival probability
for colon cancer.
4. The genetic biomarker of claim 1, wherein said biomarker is
NOX4.
5. A panel of genetic probes for assessing 5-year survival
probability without relapse in a patient population having a
cancerous left-side colon tumor, said panel consisting essentially
of the genetic probes of Table 2, Table 4, or a combination
thereof.
6. A genetic biomarker for assessing 5-year survival probability
without relapse in a patient having a cancerous right-side colon
tumor (RCC) comprising an expression level of an RNA transcript or
expression product of CDX2, FAM69A, or a combination of CDX2 and
FAM69A.
7. The genetic biomarker of claim 6 wherein a relatively low
expression level of an RNA transcript or expression product of CDX2
from a tissue harvested from a right colon tumor tissue is
predictive of a decreased 5-year relapse-free survival probability
for colon cancer.
8. The genetic biomarker of claim 6 wherein a relatively high
expression level of an RNA transcript or expression product of CDX2
from a tissue harvested from a right colon tumor tissue is
predictive of an increased 5-year relapse-free survival probability
for colon cancer.
9. A panel of genetic probes for assessing 5 year survival
probability without relapse in a patient population having a
cancerous right-side colon tumor, said panel consisting essentially
of the genetic probes of Table 1, Table 5, or a combination
thereof.
10. A method for assessing a 5-year relapse free survival
probability of a patient diagnosed with right side colon cancer
(RCC) disease, comprising: a) measuring an expression level of a
set of RCC-related genes comprising CDX2, FAM69A, or both CDX2 and
FAM69A, or an expression product thereof, from a right side colon
tissue sample obtained from the patient having RCC disease to
provide a test RCC test level; b) comparing said RCC test level to
a threshold expression level of like RCC-related genes from an RCC
colon cancer population, said RCC colon cancer population
comprising relapse and relapse-free RCC colon cancer patients, and
determining if said test expression level is higher or lower than
said threshold expression level; and c) identifying a decreased
probability without relapse for the RCC patient having a lower RCC
test expression level, and identifying an increased probability of
survival without relapse in a RCC patient having a higher RCC test
level.
11. The method of claim 10 wherein the right side colon tissue
sample is embedded in paraffin.
12. The method of claim 10 wherein a patient sample having a higher
test level of the RCC-related gene CDX2 identifies a patient who
can avoid chemotherapy without increased risk of colon cancer
relapse or metastasis.
13. The method of claim 8 wherein the set of RCC related genes
consists essentially of a CDX2 expression level.
14. A method for assessing a 5-year relapse free survival
probability of a patient diagnosed with left side colon cancer
(LCC) disease, comprising: a) measuring NOX4, MMP3, or a
combination of NOX4 and MMP3, or an expression product thereof from
a left side colon tumor tissue sample obtained from the patient to
provide a test LCC level; b) determining if said LCC test level(s)
is high or low, wherein an expression level is considered low or
high as compared to a threshold value, wherein said threshold value
is calculated from a reference set of like-gene expression levels
from a like-classified colon cancer patient population, said
like-classified patient population comprising relapse and
relapse-free colon cancer patients; and c) identifying an improved
survival probability without relapse for the patient having a low
expression level of NOX4, high expression level of MMP3, or both
according to the selection of genes in a), and identifying a
poor/lower survival probability of survival without relapse in a
patient having a high expression level of NOX4 or low expression
level of MMP3.
15. The method of claim 14 wherein the left side colon tumor tissue
is embedded in paraffin.
16. The method of claim 14 wherein the set of LCC related genes
consists essentially of a NOX4 expression level, and a patient
sample having a lower NOX4 expression level identifies a patient
who can avoid adjuvant chemotherapy without increased risk of
metastasis or relapse.
17. A computer implemented method of determining relapse free
survival probability for a patient having undergone colon cancer
surgery, said method comprising: a) classifying the colon cancer
patient as a right side colon cancer (RCC) or as a left side colon
cancer (LCC) disease patient by identifying the side of the colon
on which the colon cancer was localized and providing said
identifying classification to a receiver module; b) where the
identifying classification of the patient is LCC disease, measuring
an expression level of an RNA transcript or expression product of
NOX4 in a colon cancer tissue obtained from the LCC patient, to
provide a test NOX4 test level, and where the identifying
classification of the patient is RCC disease, measuring an
expression level of an RNA transcript or expression product of CDX2
in a colon cancer tissue obtained from the RCC patient, to provide
a test CDX2 level, and providing said expression level data to a
receiver module; and c) determining the relapse free survival
probability of the LCC patient as good in a LCC patient tissue with
a low NOX4 expression level, and a relapse-free survival
probability to a LCC patient as poor with a high NOX4 expression
level; and determining the relapse-free survival probability of an
RCC patient as poor in a RCC patient tissue with a low CDX2
expression level, and a relapse-free survival probability as good
with a high CDX2 expression level, wherein an expression level is
considered low or high as compared to a threshold value, wherein
said threshold value is calculated from a reference set of
like-gene expression levels from a like-classified colon cancer
patient population, said like-classified patient population
comprising relapse and relapse-free colon cancer patients.
18. The computer implemented method of claim 17 further including
generating a prognosis report of said LCC patient or RCC
patient.
19. A method for reducing reactive oxidative species (ROS)
production in colon cancer tissues comprising inhibiting expression
of a NOX4 gene in colon cancer cells.
20. A genetic method of classifying a colon cancer tissue sample as
a right side colon cancer or as a left side colon cancer
comprising: a) measuring a level of PRAC gene expression in the
colon cancer tissue sample; and b) determining that a colon cancer
tissue sample is a right side colon cancer where the PRAC gene
expression negligible, and determining that a colon cancer tissue
sample is a left side colon cancer sample where the PRAC gene
expression is positive.
21. A computer implemented method of determining a probability of a
lack of responsiveness to chemotherapy treatment in a patient
having had surgical intervention for right side colon cancer (RCC)
or left side colon cancer (LCC), comprising: a) classifying the
colon cancer patient as a right side colon cancer (RCC) or as a
left side colon cancer (LCC) disease patient by identifying the
side of the colon on which the colon cancer was localized and
providing said identifying classification to a receiver module; b)
where the classification of the patient is LCC disease, measuring
an expression level of an RNA transcript or expression product of
NOX4 in a colon cancer tissue obtained from the LCC patient, to
provide a test NOX4 test level, and where the identifying
classification of the patient is RCC disease, measuring an
expression level of an RNA transcript or expression product of CDX2
in a colon cancer tissue obtained from the RCC patient, to provide
a test CDX2 level, and providing said expression level data to a
receiver module; and c) determining the likelihood of response to
chemotherapy of the LCC patient as low in a patient with a low NOX4
expression level; and determining the likelihood of response to
chemotherapy of the RCC patient as low in a patient with a high
CDX2 expression level, wherein an expression level is considered
low or high as compared to a threshold value, wherein said
threshold value is calculated from a reference set of like-gene
expression levels from a like-classified colon cancer patient
population, said like-classified patient population comprising
relapse and relapse-free colon cancer patients not having received
chemotherapy.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] Priority to claimed to U.S. Provisional Patent Application
61/459,864, filed Dec. 20, 2010. Reference is hereby made to U.S.
Provisional Patent Application 61/462,592, filed Feb. 4, 2011. The
entire content of U.S. Ser. No. 61/459,865 and U.S. Ser. No.
61/462,592, is specifically incorporated herein by reference.
BACKGROUND
[0002] Thousands of people around the world have been diagnosed
with colon cancer, hundreds ultimately dying of the disease.
Patients are typically treated with colon resection surgery,
followed by radiation therapy or systemic chemotherapy, the therapy
being based on macroscopic traits of the tumor and the tumor stage.
The 5-year relapse-free survival rate is improved in some patients
receiving chemotherapy after colon surgical resection surgery,
while this statistic is not improved in others.
[0003] Diagnostic tests for predicting relapse in colon cancer
include the Oncotype DX test (Genomic Health). However, Genomic
Health's test and others reports of a test for relapse in colon
cancer is widely considered a failure. The Oncotype DX Colon test
identifies a small group of poor prognosis patients, but the test
does not isolate good prognosis patients who can avoid further
therapy, such as chemotherapy. Unfortunately, there does not exist
a prognostic test for colon cancer that provides a consistent and
accurate assessment of colon relapse risk in clinical practice.
[0004] Painful and expensive therapies, such as chemotherapy, are
typically part of a standard and routinely proscribed clinical care
management protocol for the post-colon cancer resection patient.
Chemotherapy is routinely recommended for patients with stage III
or IV tumors..sup.1 While chemotherapy is of some benefit for stage
II colon cancers.sup.1, 82% of these patients will survive for 5
years without further treatment..sup.1 Only about 10% of the
patients who do not receive chemotherapy reportedly die of the
disease within 5 years. A method of predicting the patient
population that can safely avoid chemotherapy apart from that
population that will likely benefit from chemotherapy, will save
lives, relieve thousands of people from the toxic side effects of
unnecessary chemotherapy, and save significant healthcare expense
worldwide. However, there is no reliable method in existence that
is capable of accurately predicting which of these patient
populations could successfully avoid the painful and toxic process
of chemotherapy without risk of relapse.
[0005] There is growing evidence that right-side colon cancer (RCC)
and left-side colon cancer (LCC) have significantly different
histological and molecular characteristics. For example, RCC is
more common in women than men, and patients with RCC have a poorer
prognosis than patients with LCC.sup.3,4. RCC and LCC tend to have
different gross macroscopic pathology.sup.5. At the molecular
level, a significant number of genes are differentially expressed
between RCC and LCC.sup.6, and patterns of loss of heterozygosity
and promoter methylation vary by location.sup.7.
[0006] Despite these observations, the challenge of colon cancer
treatment remains to target specific treatment regimens to
pathogenically distinct tumor types, and ultimately personalize
colon cancer treatment in order to maximize outcomes. Hence, a need
exists for materials and tests that are simultaneously prognostic
and provide predictive information about colon cancer patient
responses to treatment options. A medical need continues to exist
for improved colon cancer clinical screening tools to enable more
effective and less toxic colon cancer care and treatment
management, and that also closely correlates with a high confidence
level of long-term, relapse-free survival probability after colon
cancer resection surgery.
SUMMARY OF THE INVENTION
[0007] In a general and overall sense, the present invention
provides powerful and highly significant biomarkers for quantifying
risk of recurrence of location-specific colon cancer. The present
disclosure demonstrates that different processes dominate disease
progression in left-side colon cancer (LCC) and right-side colon
cancer (RCC), and that genes that are most predictive of relapse in
LCC are much less significant in RCC, and vice-versa. Thus, using
the information of the present disclosure, highly accurate and
specific molecular tools are provided that can identify a patient
as having LCC disease apart from those with RCC disease, and as a
consequence of this, enable methods for highly accurate and
effective techniques of prognosis assessment and treatment tailored
to the disease type of the patient. In this way, methods for
treating LCC and RCC as separate diseases are now possible.
[0008] The present disclosure identifies specific, previously
unknown, colon cancer location specific biomarkers. The specific
colon cancer biomarkers are demonstrated to have a bimodal
distribution pattern of expression. Specific biomarkers for left
side colon cancer (LCC) and for right side colon cancer (RCC) are
provided. LCC and RCC disease may be identified in the patient for
example, by measuring expression levels of PRAC gene or by the
clinical identification of the colon location site from which the
colon cancer/tumor tissue sample was harvested. Then, the RCC and
LCC biomarkers disclosed herein may be used to provide a predicted
prognosis of the patient, from which a specific LCC or RCC clinical
treatment plan may be formulated.
[0009] The specific and different genetic biomarkers of the
invention separates each disease group population of colon cancer
patients, the LCC disease group and RCC disease group population,
into a good prognosis group and a poor prognosis group.
Specifically, the LCC disease group population is divided into a
poor prognosis LCC population group and a good prognosis LCC
population group. The RCC disease group population is divided into
a poor prognosis RCC patient population group and a good prognosis
RCC patient population group. The biomarkers possess a bimodal
distribution among these specific populations of colon cancer
patients, and may be used as part of the presently described
methods to provide location specific left-side or right-side colon
cancer tumor disease assessment. Use of the biomarkers provides an
improved and more accurate quantifier of risk of colon cancer
relapse and of survival probability compared to tumor stage
alone.
[0010] The bimodal genetic biomarkers for left-side colon disease
and right side colon disease include NOX4, MMP3, CDX2 and FAM69A.
These biomarkers have particular individual and distinct genetic
expression level profiles. Differences in the expression level
profiles and their distribution within a colon cancer population,
RCC or LCC, correlates with the status of a patient as having a
good prognosis of survival or as a patient with a bad prognosis of
survival.
[0011] Genes NOX4 and MMP3 have a specific bimodal expression
profile in left side colon cancer disease colon tissue that
identifies a patient as having either a good or bad prognosis for
5-year relapse free survival.
[0012] Genes CDX2 and FAM69A have a specific bimodal expression
profile in right side colon disease colon tissues that identifies a
patient as having either a good or bad prognosis for 5-year relapse
free survival.
[0013] In specific embodiments, in a population of colon cancer
patients having left side colon cancer (LCC) disease, a patient
whose tumor expresses a high level of a specific gene or set of
genes, such as gene NOX4, are at higher risk for colon cancer
relapse within a 5 year post-surgical period. Such patients would
be identified as in need of chemotherapy or other treatment to
improve their chances of survival, whereas those expressing a low
level of NOX4 are not at a higher risk for relapse, and therefore
would not be in need of treatment such as chemotherapy or the like
to improve their chances of a 5-year relapse free survival.
[0014] In another form of colon cancer disease, in a population of
colon cancer patients having right side colon cancer (RCC) disease,
a patient whose tumor or tumor tissue (the tumor tissue being
obtained from the right side of the colon in the patient) has a low
gene expression level of a set of RCC-related genes comprising
CDX2, FAM69A, or both, compared to a threshold expression
value/level of a like-set of RCC related genes, is associated with
poor prognosis and high expression levels with good prognosis.
Here, low expression is relative to a threshold value/level of the
like RCC-related genes, such as CDX2, in a population of RCC
patients that have a known 5-year history of relapse and
relapse-free survival. In a particular embodiment, a method is
provided for prognosis of right-side colon cancer patients. As part
of this method, colon cancer patients having right-side colon
cancer disease with colon tissue expressing a low level of gene
CDX2 compared to a threshold expression value/level for CDX2, are
at higher risk for colon cancer relapse within a 5-year
post-surgical period. This patient and/or patient population would
be identified as in need of chemotherapy or other treatment to
improve their chances of survival, whereas those expressing a high
level of CDX2, are not at a higher risk for relapse, and therefore
would not be in need of treatment such as chemotherapy or the like
to improve their chances of a 5-year relapse free survival.
[0015] Relapse patients with RCC have been identified here to
demonstrate accelerated cell cycle progression and elevated Wnt
signaling. Axin 2 is also identified to be downregulated in RCC
relapse patients.
[0016] In other aspects, improved methods for managing the clinical
care of a patient having been diagnosed with colon cancer are
provided. In particular, the present invention provides, in some
aspects, a method for identifying the best clinical management for
the treatment of a left-side colon cancer (LCC) patient, following
surgical intervention to remove the cancer, as well as a method for
identifying the best clinical management for the treatment of a
right side colon cancer (RCC) patient following surgical removal of
the cancer.
[0017] In some embodiments, the assessment of gene expression
levels of a defined panel of genes may be measured using
GeneChip.RTM., or microarray technology. While any number of
standard microarray platforms known to those of skill in the art
may be used, an example of one commercially available microarray is
the GeneChip.RTM.. (Affymetrix.RTM..).
Right Side Colon Cancer (RCC)--Biomarkers, RCC Disease and
Treatment:
[0018] Biomarker for Right-Side colon cancer--CDX2, FAM69A, CDKN2B,
GADD45A and CCND1. Other RCC indicative molecules associated with
relevant RCC biological pathways include cyclic dependent kinase
inhibitor 2B (CDKN2B), growth arrest and DNA damage inducible,
alpha (GADD45A) and cyclin D1 (CCND1).
[0019] A significant percentage of RCC patients that experience a
colon cancer relapse after surgical intervention have been
determined, according to the methods of the present invention, to
present right side colon cancer samples that demonstrate low
expression levels of caudal type homeobox 2(CDX2). Here, low
expression is relative to the DCX2 expression levels of the RCC
cancer tumors in a population of all RCC cancer patients. Unlike
other CDX2 tests, the present model provides a highly prognostic
indicator concerning relative risk for recurrent colon cancer
relapse. Prior description of the use of the CDX2 gene as a colon
cancer has been mixed, with the CDX2 gene having been used only in
identifying a patient as having a cancer of the right side of the
colon or not..sup.23 While some report CDX2 as increased in colon
tumors, others report it decreased.
[0020] According to the present invention, a RCC patient with low
CDX2 expression levels, accordingly, would likely be proscribed a
more aggressive, post colon surgery, treatment regimen, such as
chemotherapy and/or radiation therapy.
[0021] Conversely, a RCC patient with relatively high expression
levels of CDX2 has a lower risk of recurrence than the overall
population of patients diagnosed with RCC disease. The 5-year
expected survival probability is sufficiently high that the patient
would not benefit from systemic chemotherapy, radiation therapy, or
other post-colon cancer resection surgery.
[0022] Patient samples from RCC patients having a high probability
of colon cancer relapse, and a decreased probability of 5-year
survival probability without relapse, also evidence down regulation
of Axin 2, elevated levels of cyclic dependent kinase inhibition 2B
(CDKN2B), elevated expression levels of growth arrest and DNA
damage inducible, alpha (GADD45A), and elevated expression levels
of cyclin D1 (CCND1).
[0023] Table 1 provides a chart of the biomarker genes, and the
probes employed to assess the gene expression. These commercially
available gene probe families are provided here for example only,
as other genetic probes for the identified biomarker genes may be
devised by one of skill in the at and employed in the practice of
the present invention employing the teachings of the present
disclosure.
TABLE-US-00001 TABLE 1 PROGNOSIS PROBE SYMBOL NAME ACCN POOR GOOD
216044_x_at FAM69A family with sequence AK027146 LOW HIGH
similarity 69, member A 206387_at CDX2 caudal type homeobox 2
U51096 LOW HIGH 225582_at ITPRIP inositol 1,4,5-trisphosphate
AA425726 HIGH LOW receptor interacting protein 201474_s_at ITGA3
integrin, alpha 3 (antigen NM_002204 HIGH LOW CD49C, alpha 3
subunit of VLA-3 receptor) 225667_s_at FAM84A family with sequence
AI601101 LOW HIGH similarity 84, member A 227123_at RAB3B RAB3B,
member RAS AU156710 HIGH LOW oncogene family 218284_at SMAD3 SMAD
family member 3 NM_015400 HIGH LOW 205559_s_at PCSK5 proprotein
convertase NM_006200 HIGH LOW subtilisin/kexin type 5 219909_at
MMP28 matrix metallopeptidase 28 NM_024302 HIGH LOW
[0024] The good prognosis component of CDX2 in the right-side
samples in GSE14333 contains 84% of the samples. The good prognosis
component defined by using both CDX2 and FAM69A contains 80% of the
samples.
[0025] NOX4 is largely unexpressed in RCC. This means that a test
that examines NOX4 in a patient having RCC disease will result in a
false "good prognosis" assessment of the patient.
[0026] As used in the description of the present invention, RCC
refers to a tumor tissue and/or cancerous tissue that is identified
from tissue harvested from the right side of the colon. The right
side of the colon will be understood in the description of the
present invention as that part of the human colon that extends from
the cecum or ascending colon and extends through the transverse
colon, excluding the appendix.
Left Side Colon Cancer (LCC)--Biomarkers, Disease and
Treatment:
[0027] Biomarker for Left-Side Colon Cancer--NOX4 and MMP3.
[0028] The NOX family of genes has been implicated in cancer
development by reactive oxygen species (ROS) in several forms of
cancer.sup.12, but NOX4 has not been previously implicated in colon
cancer progression.
[0029] A higher percentage of LCC patients that experience a colon
cancer relapse after surgical intervention have been determined,
according to the methods of the present invention, to present left
side colon cancer samples with a higher expression levels of NOX4.
These patient samples also evidence elevated integrin-binding
sialoprotein (IBSP), and lower expression levels of matrix
metallopeptidase 3 (stromelysin 1, progelatinase) (MMP3).
[0030] Therefore, a higher NOX4 expression level in a left-side
colon cancer tissue would be indicative of a higher risk of colon
cancer relapse. Thus, this patient population would more likely
benefit in a higher probability of increased survival without
relapse and decreased risk of colon cancer metastasis if
additional, post-colon surgery, treatments were administered, such
as chemotherapy and/or radiation therapy.
[0031] A LCC patient with low NOX4 expression levels has a high
probability of relapse-free survival for 5 years. Such a patient is
unlikely to benefit from systemic chemotherapy, radiation therapy,
or other post colon cancer resection surgery procedure.
[0032] In some embodiments, a panel of gene biomarkers for good
prognosis LCC patients may be obtained by combining 2 or more genes
in Table 2. A set of good prognosis patients is the intersection of
the good prognosis components of the individual genes in the panel.
Table 2 provides a chart of the biomarker genes, and the probe
employed to assess the gene expression. These are exemplary, as
other genetic probes for the identified biomarker genes may be
devised by one of skill in the at and employed in the practice of
the present invention employing the teachings of the present
disclosure.
TABLE-US-00002 TABLE 2 PROGNOSIS PROBE SYMBOL NAME ACCN POOR GOOD
205828_at MMP3 matrix metallopeptidase 3 NM_002422 LOW HIGH
(stromelysin 1, progelatinase) 230748_at SLC16A6 solute carrier
family 16, AI873273 HIGH LOW member 6 (monocarboxylic acid
transporter 7) 205990_s_at WNT5A wingless-type MMTV NM_003392 LOW
HIGH integration site family, member 5A 202435_s_at CYP1B1
cytochrome P450, family 1, AU154504 HIGH LOW subfamily B,
polypeptide 1 219773_at NOX4 NADPH oxidase 4 NM_016931 HIGH LOW
236028_at IBSP integrin-binding sialoprotein BE466675 HIGH LOW
205286_at TFAP2C transcription factor AP-2 U85658 HIGH LOW gamma
(activating enhancer binding protein 2 gamma) 206091_at MATN3
matrilin 3 NM_002381 HIGH LOW 204672_s_at ANKRD6 ankyrin repeat
domain 6 NM_014942 HIGH LOW
A panel of gene biomarkers for good prognosis LCC patients is
obtained by combining 2 or more genes in Table 5. A set of good
prognosis patients is the intersection of the good prognosis
components of the individual genes in the panel.
[0033] Conversely, a LCC patient with high NOX4, would likely be
proscribed an aggressive post colon surgery treatment regimen. It
is anticipated that this population of patients would benefit from
an increase in probability of relapse free survival, or decreased
probability of colon cancer metastasis, with subsequent aggressive
clinical treatment, such as chemotherapy and/or radiation therapy.
The good prognosis component of NOX4 in the left-side samples in
GSE14333 contains 56% of the samples. The good prognosis component
defined by using both NOX4 and MMP3 contains 51% of the
samples.
[0034] As used in the description of the present invention, LCC
refers to a tumor tissue and/or cancerous tissue that is identified
from tissue harvested from the left side of the colon. The left
side of the colon will be understood in the description of the
present invention as that part of the human colon that begins at
the left splenic flexure, includes the descending colon and ends
with the sigmoid, but does not include the rectum.
[0035] In LCC samples, elevated expression of NADPH oxidase 4
(NOX4) (as compared to a threshold expression value/level of the
gene in a LCC population of patients that have at least a 5-year
history of relapse or as relapse-free) is highly predictive of
relapse in post-colon surgery patients. CDX2 has normal expression
levels in most LCC relapse cases.
[0036] The present analysis of the pathways affected by these genes
point to their central role in colon cancer progression, giving a
high level of confidence in these results.
Gene Panel Probes and Micro-Array Methods for Colon Disease
Screening:
[0037] The present invention also provides a panel of genetic
probes for assessing 5 year survival probability without relapse in
a patient population having a cancerous left-side colon (LCC)
tumor. These genetic probes are described herein in Tables 2 and
4.
[0038] The present invention also provides a panel of genetic
probes for assessing 5 year survival probability without relapse in
a patient population having a cancerous right-side colon (RCC)
tumor. These genetic probes are described herein at Tables 1 and
5.
[0039] There are numerous other genes that can replace the genes
presented in the present model with little loss of significance, so
this should be viewed as a family of equivalent tests. RT-PCR in
human colon cancer cell lines are demonstrated to have expected
expression levels of the genes described as part of the present
genetic panels, given the specific characteristics of the source
tumors. Thus, the studies conducted with these cells lines are
predictive of the expected gene expression characteristics of colon
cancer in vivo.
[0040] Methods of the invention can be utilized in a number of
different applications. For example, diagnostic chips can be
fabricated based on the identification of the diagnostic genes,
such as the ones identified herein at Tables 4 and 5. Such chips
would be useful in clinical settings, as it would allow clinicians
to diagnose a particular type of colon cancer from a relatively
small set of genes, instead of purchasing entire gene sets.
[0041] The methods of the present invention may take the form of a
diagnostic and/or screening tool that is provided in the form of an
array of genetic probes specific for the colon cancer biomarkers
described herein.
[0042] The term "array" as used in the present invention refers to
a grouping or an arrangement, without being necessarily a regular
arrangement. An array comprises preferably at least 2, more
preferably 5 different sets of detection molecules or patient
samples. Preferably, the array of the present invention comprises
at least 50 sets of detection molecules or patient samples, further
preferred at least 100 sets of detection molecules or patient
samples. The detection molecule can be for example a nucleic acid
probe, such as the nucleic acid probes provided at Table 4 (for LCC
disease), Table 5 (for RCC disease), or in some embodiments, the
nucleic acid probes of both Tables 4 and 5. The described array can
be used in a test system according to the invention. The array can
be either a micro array or a macro array.
[0043] The detection molecules are immobilized to a solid surface
or support or solid support surface. This array or microarray is
then screened by hybridizing nucleic acid probes prepared from
patient samples or by contacting the array with proteinaceous
probes prepared from patient samples.
[0044] The support can be a polymeric material such as nylon or
plastic or an inorganic material such as silicon, for example a
silicon wafer, or ceramic. Pursuant to a preferred embodiment,
glass (SiO2) is used as solid support material. The glass can be a
glass slide or glass chip. Pursuant to another embodiment of the
invention the glass substrate has an atomically flat surface.
[0045] Methods of the invention can also be used for identifying
pharmaceutical targets. Pharmaceutical companies can utilize
methods of the invention to determine which genes to target in
efforts to target specific right-side colon disease or left-side
colon disease.
[0046] The method may further include the step of producing a
report indicating a RCC or LCC prognosis for the colon cancer
patient based on the expression levels and a comparison to other
patients with similar expression levels, and optionally,
calculating a recurrence score based on the expression levels.
Computerized Methods:
[0047] According to an embodiment of the invention, any of the
steps of the methods may be performed by a computer. In one
embodiment, the expression level of the gene panel is performed by
microarray analysis with multi-state probes specific to the genes
of the gene panel.
[0048] In one embodiment, a computer running a software program
analyzes gene expression level data from a patient, compares that
data to a distribution of expression levels from a population of
colon patients having a RCC or LCC disease state, and determines
whether the patient's expression levels have a +/- status for each
gene identified herein as informative to an RCC or LCC prognosis,
respectively.
[0049] As described herein, the +/- status of a LCC or RCC
patient's colon tumor tissue gene expression is determined based on
comparing that patient's colon sample tissue level of gene
expression to the density distribution of gene expression from all
LCC or RCC patients in a sample group. In one embodiment, density
distribution of expression levels from the sample population is
determined based on mixture model fit statistical method which is a
statistical method know to those of skill in the art. A key
discovery according to one aspect of the invention as described
herein is that the expression by LCC or RCC cancer patients of
multi-state genes, as described herein, presents at least a bimodal
distribution when the expression level density distribution is
determined using the mixture model fit method. Because of this at
least bimodal distribution, it is possible to determine a threshold
whereby on one side of the threshold, the level of gene expression
is low and on the other side of the threshold, the level of gene
expression is high. Correlation of a high expression level or low
expression level to a good or bad prognosis depends on the type of
colon cancer disease as LCC or RCC, as well as the specific bimodal
gene expression level being examined, as is more fully described
herein.
[0050] Based on the expression level status for each gene, the
computer software is capable of determining the prognosis for the
patient as being good or poor. For example, the software is capable
of generating a report summarizing the patient's gene expression
levels and/or the patient's (+) or (-) status scores, and/or a
prediction of the likelihood of long term survival of the patient
and/or the likelihood of recurrence or metastasis of the patient's
LCC or RCC disease condition. Further, in one embodiment, the
computer program is capable of performing any statistical analysis
of the patient's data or a population of patient's data as
described herein in order to generate the + or - status of the
patient.
[0051] Further, in one embodiment, the computer program is also
capable of normalizing the patient's gene expression levels in view
of a standard or control prior to comparison of the patient's gene
expression levels to those of the patient population. In some
embodiments, the computer is capable of ascertaining raw data of a
patient's expression values from, for example, immunohistochemical
staining or a microarray, or, in another embodiment, the raw data
is input into the computer.
Reactive Oxidative Species (ROS) Production in Colon Cancer:
[0052] Methods for inhibiting reactive oxidative species production
in colon cancer cells are provided, wherein carcinogenic colon
cancer shall be inhibited. Overproduction of reactive oxidative
species (ROS) have long been implicated in the aggressiveness of
cancer tumors. Interference RNA for NOX4 may be used to inhibit the
aggressiveness of LCC tumors by reducing ROS production. ROS
production in a colon cancer cell line, SW620, was reduced by
inhibiting NOX4 mRNA using interference RNA. ROS production in LCC
may also be inhibited by interfering with the activity of the NOX4
protein using an antibody.
[0053] The methods of the present invention are carried out with
colon sample material such as a colon tumor tissue sample which
already has been isolated from the human body. Subsequently the
sample material can be fractionated and/or purified. It is for
example possible, to store the sample material to be tested in a
freezer and to carry out the methods of the present invention at an
appropriate point in time after thawing the respective sample
material.
[0054] After transformation of colorectal adenoma into colorectal
cancer, the pathological condition of the afflicted individual can
be further exacerbated by formation of metastasis. The present
invention may be used to discriminate and identify early colon
cancer, thus permitting the detection of the colon cancer disease
at an early and still benign stage, an early stage or benign stage
and/or early colon tumor stages. The early detection enables the
physician to timely remove the colorectal adenoma and to
dramatically increase the chance of the individual to survive.
[0055] According to the invention, the expression levels from the
population of right side colon cancer (RCC) disease patients or
left side colon cancer (LCC) disease patients for each gene in the
colon cancer gene panel comprises a bimodal density distribution
such that a statistically significant threshold exists between the
two modes, whereby expression levels on one side of the threshold
are deemed high and expression levels on the other side of the
threshold are deemed low. The LCC or RCC patient sample is
classified as demonstrating a relatively low expression level or a
relatively high expression level of the informative gene or set of
genes for LCC or RCC as defined here (See Tables 1 and 2), and the
expression level is compared to a threshold expression value/level
of a like gene or set of like genes. The prognosis in the RCC or
LCC patient is then assessed based upon the specific gene
expression data obtained from an existing pool of genetic
expression profile data collected from the RCC or LCC disease
patients, respectively, having a known positive 5 year colon cancer
free survival history and a specific LCC or RCC genetic profile
expression level data set. By way of example, this data set is a
data set of mRNA expression values for NOX4 and MMP3 (for LCC), and
CDX2 and FAM69A (for RCC).
[0056] The expression level profiles and diagnostic methods of the
present RCC and LCC disease models provided here employing the
bimodal genes identified for RCC and LCC are completely independent
of and unrelated to the estrogen receptor (+) or (-) status of the
tissue sample and any bimodal gene identified for breast cancer,
and is unrelated to assessment of breast cancer prognosis or risk
of relapse for breast cancer.
[0057] According to a further embodiment, the density distribution
is determined by mixture model fit statistical analysis. According
to one embodiment, the expression levels of each RCC or LCC gene
from the respective population of RCC or LCC patients forms a
density distribution of at least two or more modes and a
statistically significant threshold exists between the two or more
modes. Expression levels on one side of a defined threshold are
deemed positively correlated with mortality and expression levels
on the other side of a defined threshold are positively correlated
with survival. According to a further embodiment, the density
distribution is determined by mixture model fit statistical
analysis.
[0058] A data set of mRNA expression values may be generated using,
for example, an Affymetrix, microarray. One array may be generated
for each patient in the cohort. Consider an array probe p such that
increased expression is statistically significant in a univariate
Cox proportional hazard model of relapse.
[0059] For purposes of the present methods, "p" is designated
multi-state in this cohort if the density distribution can be
partitioned into two components: a large normal component of
expression values below a threshold c, and a long right tail with
expression values above c. The component of high expression values,
denoted "p+", contains a greater percentage of patients who relapse
than the component of low expression values, denoted "p-".
BRIEF DESCRIPTION OF THE FIGURES
[0060] FIG. 1. Elevated NOX4 expression is a significant predictor
of relapse in left-side colon cancer. (a) The density distribution
of NOX4 expression in the left-side tumors on GSE14333 with Dukes
Stage A, B or C shows a large component with low baseline
expression and a tail of elevated expression values. Individual
expression values are indicated with hatch marks at the lower edge.
The multistate methodology divides the samples at an expression
value of 3.1; the samples with expression below 3.1 are in the
NOX4- component, and those with expression values above 3.1 are in
NOX4+. (b) In the same set of left-side tumors, the relapse event
vector gives a sample the value 0 if it is relapse-free for 60
months and the value 1 otherwise. The boxplot of NOX4 expression
versus the relapse event vector illustrates the significance of the
dependence. (c) The Kaplan-Meier curves for the NOX4- and NOX4+
components plot the expected survival probabilities for the
components in the left-side tumors. The 5-year expected survival
probability for NOX4- is 0.89 95% CI (0.80-0.99) and for NOX4+ it
is 0.51 95% CI (0.37-0.70). A Cox proportional hazard model whose
only variable is an indicator for the NOX4 components has a logrank
test p-value 1.2.times.10.sup.-4. NOX4- contains 53 samples and
NOX4+ contains 42 samples. (d) The corresponding Kaplan-Meier plots
for the NOX4 components in the right-side tumors shows a distinctly
lower connection with relapse than on the left side. The 5-year
expected survival for NOX4- on the right side is 0.82 95 C1%
(0.73-0.93) and for NOX4+ it is 0.73 95% CI (0.56-0.95). On the
right side only 28 samples are in NOX4+ and 72 are in NOX4-.
[0061] FIG. 2. Low CDX2 expression is a significant predictor of
relapse in right-side colon cancer. (a) The density distribution of
CDX2 expression in the right-side tumors on GSE14333 with Dukes
Stage A, B or C follows a bimodal distribution. The multistate
methodology divides the samples at an expression value of 4.76; the
samples with expression below 4.76 are in the CDX2- component, and
those with expression values above 4.76 are in CDX2+. (b) The
boxplot of CDX2 expression versus the relapse event vector
illustrates the significance of the dependence. In this case, low
CDX2 expression is predictive of relapse. (c) The Kaplan-Meier
curves for the CDX2+ and CDX2- components plot the expected
survival probabilities for the components in the right-side tumors.
The 5-year expected survival probability for CDX2+ is 0.88 95% CI
(0.80-0.96) and for CDX2- it is 0.39 95% CI (0.15-0.78). A Cox
proportional hazard model whose only variable is an indicator for
the CDX2 components has a logrank test p-value
1.68.times.10.sup.-7. CDX2+ contains 86 samples and CDX2- contains
16 samples. (d) The corresponding Kaplan-Meier plots for the CDX2
components in the left-side tumors shows a distinctly lower
connection with relapse than on the right side. The 5-year expected
survival for CDX2+ on the left side is 0.75 95 C1% (0.66-0.86) and
for CDX2- it is 0.35 95% CI (0.12-1.0). On the left side 10 samples
are in CDX2- and 85 are in CDX2+.
[0062] FIG. 3. Expression of endogenous NOX4 in human colon cancer
cell lines. RTPCR was performed using RNA from several human colon
cancer cell lines (HCT116, HT29, SW480 and SW620) with specific
primers for NOX4. NOX4 mRNA levels were quantified using the
comparative C.sub.T method relative to levels of hypoxanthine
phosphoribosyltransfease (HPRT). The fold change in expression
(Log.sub.10) was normalized to normal colon NOX4 mRNA levels. Three
experiments were conducted in triplicate. Bars represent the median
fold change (Log.sub.10) and the error bars represent the standard
deviation.
[0063] FIG. 4. siRNA suppression of NOX4 does not affect SW620 cell
viability. (A) RTPCR results showing transfection with NOX4 siRNA
reduces NOX4 mRNA levels in SW620 cells compared with control
AllStar negative siRNA. A positive control AllStar Death siRNA was
also used to validate transfection efficiency (data not shown). (B)
Cell viability was normalized to AllStar negative transfected SW620
cells. NOX4 siRNA and AllStar negative siRNA transfected SW620 cell
have similar cell viability. Assays were performed in triplicate.
Similar results were obtained in two separate experiments.
[0064] FIG. 5. Targeted NOX4 knockdown decreases superoxide
production in SW620 cells. SW620 cells were transfected with NOX4
siRNA and assayed for superoxide production by the chemiluminescent
method. Superoxide producing activity of AllStar negative siRNA
transfected cells are set as 100%. Each bar represents the mean
data from 2 independent transfections, with error bars representing
the S.D. for percentage of activity.
[0065] FIG. 6. Flow chart of screening a colon cancer patient. This
flow chart may be embodied as a software program that may be used
in an automated clinical tool for screening patient samples.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0066] The present invention, in a general and overall sense,
provides for biomarkers specific for left side colon cancer (LCC)
and for right side colon cancer (RCC), as well as the use of these
markers in providing powerful diagnostic and prognostic tools for
predicting survival probabilities of patients with each
disease.
[0067] In some embodiments, the invention provides for a method of
measuring expression levels of the biomarker NOX4, MMP3, or a
combination of these as an assessment indicator of left-side colon
cancer (LCC) prognosis.
[0068] In another embodiment, the invention provides for a method
of measuring expression levels of the biomarker CDX2, FAM69A, or a
combination of these, as an assessment indicator of right-side
colon cancer (RCC) prognosis.
[0069] In some embodiments, and to better facilitate use in
conjunction with current practices in surgery and pathology, a
clinically applicable version of the present methods may use RT-PCR
to measure mRNA obtained from formalin-fixed, paraffin-embedded
(FFPE) colon tissue.
[0070] The present invention demonstrates that different processes
dominate progression to relapse in LCC and RCC. Using a microarray
database and a method of building survival models, it is
demonstrated here that genes that are most predictive of relapse in
LCC are much less significant in RCC, and vice-versa. In
particular, in the LCC samples, elevated expression of NADPH
oxidase 4 (NOX4) is highly predictive of relapse, while NOX4 is
largely unexpressed in RCC. The NOX family of genes has been
implicated in cancer development by reactive oxidative species
(ROS) in several forms of cancer.sup.14, but NOX4 has not been
previously implicated in colon cancer progression. A significant
percentage of the RCC samples that relapse have low expression
levels of caudal type homeobox 2 (CDX2), while CDX2 has normal
expression levels in most LCC relapse cases. Thus, it is shown that
the LCC and RCC diseases posses non-overlapping diagnostic
indicators that are specific for the disease, permitting more
targeted treatment of the colon cancer patient.
[0071] The role of NOX4 in colon cancer is further investigated
using the SW620 lymph-node metastasis colon adenocarcinoma cell
line and RNA interference. NOX4 is expressed in the SW620 cell
line, and application of NOX4 siRNA causes a significant reduction
in ROS production.
[0072] Definitions: One skilled in the art will recognize many
methods and materials similar or equivalent to those described
herein, which could be used in the practice of the present
invention. Indeed, the present invention is in no way limited to
the methods and materials described. For purposes of the present
invention, the following terms are defined below.
[0073] The term "sample material" is also designated as
"sample".
[0074] The term "biomarker" is meant to designate a protein or
protein fragment or a nucleic acid which is indicative for the
incidence of the colorectal adenoma and/or colorectal carcinoma.
That means the "biomarker" is used as a mean for detecting
colorectal adenoma and/or colorectal carcinoma.
[0075] Unless defined otherwise, technical and scientific terms
used herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this invention belongs.
Singleton, et al., Dictionary of Microbiology and Molecular Biology
2nd ed., J. Wiley & Sons (New York, N.Y. 1994), and March,
Advanced Organic Chemistry Reactions, Mechanisms and Structure 4th
ed., John Wiley & Sons (New York, N.Y. 1992), provide one
skilled in the art with a general guide to many of the terms used
in the present application.
[0076] As used in the description of the present invention, "p" is
defined as a microarray probe for a defined gene expression
product. As used in the description of the present invention, a
"multi-state gene" is defined as a gene capable of differential
levels of expression within a LCC or RCC disease patient population
such that the expression levels of the gene in the LCC or RCC
disease patient population permits the patient population to be
divided into at least two or more distribution groups based on
density distribution according to statistical analysis of the
expression level of specific LCC-associated (such as NOX4 and MMP3)
or RCC associated (such as CDX2 and FAM69A) informative genes. For
example, in one embodiment, the expression levels are divided into
two groups based on a mixture model fit of expression levels of the
gene of interest. In one embodiment, if the density distribution of
gene expression for a particular gene of interest can be
partitioned into at least two components, a large normal component
of expression values below a threshold c, and a long right tail
with expression values above c, the gene is a multi-state gene.
Alternatively, in another embodiment, a gene is multi-state if the
density distribution of gene expression for a particular gene of
interest is partitioned into at least two components, a large
normal component of expression values above a threshold c, and a
long left tail with expression values below c.
[0077] Mixture Models. Given a numeric vector, the statistical
method of finite mixture models partitions the vector into
components, each of which is modeled by a different density
distribution. The mixture models used to develop the methods
described herein fit a pair of gaussian distributions to a vector.
Such a model is described by a partition of the vector into
components C1, C2, and a pair of gaussian distributions g1, g2
modeling the distributions of C1, C2, respectively. The modeling
process simultaneously partitions the vector and selects the means,
.mu.1, .mu.2 and standard deviations .sigma.1, .sigma.2 of the two
gaussian distributions, with the goal of giving the best possible
fit over all alternatives. The fitting algorithm actually produces,
for each point and component, a posterior probability that the
point is in that component. The point is assigned to the component
whose associated posterior probability is maximal. For a point p
that is well-classified in, say, component 1, the posterior
probability that p is in C2 will be very small. For convenience,
posterior probabilities below a threshold .DELTA. are reported as
0. Following Leisch 2004, we use .DELTA.=10-4. Points that are on
the boundary between the two components will have posterior
probability>.DELTA. for both components. The "isolatedness" of,
e.g., component 1 is assessed by the ratio, r1=n1/m1, where n1 is
the size of C1 and m1 is the number of elements with posterior
probability of belonging to C1 greater than .DELTA.. Ratios are
.ltoreq.1, with numbers close to 1 representing well-isolated
components. Ratios are used to measure the ability of a mixture
model fit to describe distinct states.
[0078] In most instances, the components defined by a fit of a pair
of gaussian distributions consist of a pair of unbroken intervals.
That is, there is a cutoff c so that one component consists of the
values<c and the other component the values greater than or
equal to c. In this way, mixture models can be used to calculate a
threshold for dividing a vector into high and low components.
[0079] A standard measure of the quality of a mixture model fit is
the likelihood, which is the product, over all points, of the
maximal posterior probabilities. The likelihood can be used to
decide, for example, if a fit with a pair of gaussian distributions
is better than a fit with a single gaussian, or if a fit with Gamma
distributions is better than a fit with gaussian distributions.
Even better measures are AIC and BIC which adjust likelihood by the
degrees of freedom. These measures play a part in defining the
notion of a multi-state probe. According to one embodiment of this
invention, mixture models were fit using the flexmix R package
(Leisch, 2004).
[0080] "Probe" means a polynucleotide molecule capable of
hybridizing to a target polynucleotide molecule. For example, the
probe could be DNA, cDNA, RNA, or mRNA. In one embodiment, a probe
is fixed, for example, by a covalent bond, to a solid state
apparatus such as a microarray. The probe and the target may
hybridize, for example, under stringent, or moderately stringent
conditions. A probe may be labeled, for example, with a fluorescent
or radiolabel to permit identification. In one embodiment, a probe
is of a sufficient number of base pairs such that it has the
requisite identity to bind uniquely with the target and not with
other polynucleotide sequences such that the binding between the
target and the probe provides a statistically significant level of
accurate identification of the target molecule. In one embodiment,
a probe's ability to bind a target is correlated to a statically
significant prognostic indicator of a defined disease state as
determinable using an identified panel of genes of interest. In one
embodiment, the target is mRNA and the probe is a complementary
piece of DNA or cDNA. In another embodiment, the target is cDNA or
DNA and the probe is a complementary piece of mRNA. In another
embodiment, the target is cDNA or DNA and the probe is a
complementary piece of DNA.
[0081] The term "multi-state probe" is meant, in one embodiment, as
a probe capable of hybridizing with a target polynucleotide
molecule encoding a LCC or RCC specific multi-state gene. In
another embodiment, a "multi-state LCC or RCC probe" means a probe
capable of hybridizing with a target polynucleotide molecule
encoding a relevant portion or fragment of a LCC or RRC multi-state
gene, respectively. For example, the target polynucleotide molecule
may be mRNA.
[0082] In one embodiment, a LCC or RCC multi-state probe (see
Tables 1, 2, 4 or 5, respectively) is fixed to a solid state
apparatus such as a microarray by, for example, a covalent bond. In
one embodiment, hybridization between the probe and the target
occurs under stringent conditions.
[0083] The term "hybridize" or "hybridizing" or "hybridization"
refers to the formation of double stranded nucleic acid molecule
between complementary sequences by way of Watson-Crick
base-pairing. Hybridization can occur at various levels of
stringency according to the invention. "Stringency" of
hybridization reactions is readily determinable by one of ordinary
skill in the art, and generally is an empirical calculation
dependent upon probe length, washing temperature, and salt
concentration. In general, longer probes require higher
temperatures for proper annealing, while shorter probes need lower
temperatures. Hybridization generally depends on the ability of
denatured DNA to reanneal when complementary strands are present in
an environment below their melting temperature. The higher the
degree of desired homology between the probe and hybridizable
sequence, the higher the relative temperature which can be used. As
a result, it follows that higher relative temperatures would tend
to make the reaction conditions more stringent, while lower
temperatures less so. For additional details and explanation of
stringency of hybridization reactions, see Ausubel, et al., Current
Protocols in Molecular Biology, Wiley Interscience Publishers,
(1995).
[0084] "Stringent conditions" or "high stringency conditions", as
defined herein, typically: (1) employ low ionic strength and high
temperature for washing, for example 0.015 M sodium chloride/0.0015
M sodium citrate/0.1% sodium dodecyl sulfate at 50.degree. C.; (2)
employ during hybridization a denaturing agent, such as formamide,
for example, 50% (v/v) formamide with 0.1% bovine serum
albumin/0.1% Ficoll/0.1% polyvinylpyrrolidone/50 mM sodium
phosphate buffer at pH 6.5 with 750 mM sodium chloride, 75 mM
sodium citrate at 42.degree. C.; or (3) employ 50% formamide,
5.times.SSC (0.75 M NaCl, 0.075 M sodium citrate), 50 mM sodium
phosphate (pH 6.8), 0.1% sodium pyrophosphate, 5.times.Denhardt's
solution, sonicated salmon sperm DNA (50 .mu.g/ml), 0.1% SDS, and
10% dextran sulfate at 42.degree. C., with washes at 42.degree. C.
in 0.2..times.SSC (sodium chloride/sodium citrate) and 50%
formamide at 55.degree. C., followed by a high-stringency wash
consisting of 0.1.times..SSC containing EDTA at 55.degree. C.
"Moderately stringent conditions" may be identified as described by
Sambrook, et al., Molecular Cloning: A Laboratory Manual, New York:
Cold Spring Harbor Press, 1989, and include the use of washing
solution and hybridization conditions (e.g., temperature, ionic
strength and % SDS) less stringent that those described above. An
example of moderately stringent conditions is overnight incubation
at 37.degree. C. in a solution comprising: 20% formamide,
5.times.SSC (150 mM NaCl, 15 mM trisodium citrate), 50 mM sodium
phosphate (pH 7.6), 5.times.Denhardt's solution, 10% dextran
sulfate, and 20 mg/ml denatured sheared salmon sperm DNA, followed
by washing the filters in 1.times..SSC at about 37-50.degree. C.
The skilled artisan will recognize how to adjust the temperature,
ionic strength, etc., as necessary to accommodate factors such as
probe length and the like.
[0085] The term "microarray" refers to an ordered arrangement of
hybridizable array elements, preferably polynucleotide probes, on a
substrate.
[0086] The terms "differentially expressed gene," "differential
gene expression," and their synonyms, which are used
interchangeably, refer to a gene whose expression is activated to a
higher or lower level in a subject suffering from a LCC or RCC
disease, relative to its expression in a normal or control subject.
The terms also include genes whose expression is activated to a
higher or lower level at different stages of the same disease. It
is also understood that a differentially expressed gene may be
either activated or inhibited at the nucleic acid level or protein
level, or may be subject to alternative splicing to result in a
different polypeptide product. Such differences may be evidenced by
a change in mRNA levels, surface expression, secretion or other
partitioning of a polypeptide, for example. Differential gene
expression may include a comparison of expression between two or
more genes or their gene products, or a comparison of the ratios of
the expression between two or more genes or their gene products, or
even a comparison of two differently processed products of the same
gene, which differ between normal subjects and subjects suffering
from a disease, specifically cancer, or between various stages of
the same disease. Differential expression includes both
quantitative, as well as qualitative, differences in the temporal
or cellular expression pattern in a gene or its expression products
among, for example, normal and diseased cells, or among cells which
have undergone different disease events or disease stages. For the
purpose of this invention, "differential gene expression" is
considered to be present when there is at least an about two-fold,
preferably at least about four-fold, more preferably at least about
six-fold, most preferably at least about ten-fold difference
between the expression of a given gene in normal and diseased
subjects, or between various stages of disease development in a
diseased subject.
[0087] The term "over-expression" with regard to an RNA transcript
is used to refer to the level of the transcript determined by
normalization to the level of reference mRNAs, which might be all
measured transcripts in the specimen or a particular reference set
of mRNAs.
[0088] The term "prognosis" is used herein to refer to the
prediction of the likelihood of LCC or RCC cancer-attributable
death or progression, including recurrence, metastatic spread, and
drug resistance, of a neoplastic disease, such as RCC or LCC
disease.
[0089] The term "prediction" is used herein to refer to the
likelihood that a patient will respond either favorably or
unfavorably to a drug or set of drugs, and also the extent of those
responses, or that a patient will survive, following surgical
removal or the primary LCC or RCC tumor and/or chemotherapy for a
certain period of time without cancer recurrence. The predictive
methods of the present invention can be used clinically to make
treatment decisions by choosing the most appropriate treatment
modalities for any particular patient. The predictive methods of
the present invention are valuable tools in predicting if a patient
is likely to respond favorably to a treatment regimen, such as
surgical intervention, chemotherapy with a given drug or drug
combination, and/or radiation therapy, or whether long-term
survival of the patient, following surgery and/or termination of
chemotherapy or other treatment modalities is likely.
[0090] The term "long-term" survival is used herein to refer to
survival for at least 3 years according to one embodiment, at least
8 years according to a more preferred embodiment, and at least 10
years according to a most preferred embodiment, following surgery
or other treatment.
[0091] The term "tumor," as used herein, refers to all neoplastic
cell growth and proliferation, whether malignant or benign, and all
pre-cancerous and cancerous cells and tissues.
[0092] The terms "cancer" and "cancerous" refer to or describe the
physiological condition in mammals that is typically characterized
by unregulated cell growth.
[0093] The "pathology" of cancer includes all phenomena that
compromise the well-being of the patient. This includes, without
limitation, abnormal or uncontrollable cell growth, metastasis,
interference with the normal functioning of neighboring cells,
release of cytokines or other secretory products at abnormal
levels, suppression or aggravation of inflammatory or immunological
response, neoplasia, premalignancy, malignancy, invasion of
surrounding or distant tissues or organs, such as lymph nodes,
etc.
[0094] The term "at least one," "at least two," "at least five,"
etc., of the genes listed in any particular gene set means any one
or any and all combinations of the genes listed.
[0095] The term "node negative" cancer, such as "node negative"
colon cancer, is used herein to refer to cancer that has not spread
to the lymph nodes.
[0096] The term "gcrma" refers to a method know to those of skill
in the art whereby raw data obtained from an Affymetrix.RTM.
microarray is normalized;
[0097] "Normalization" refers to statistical normalization. For
example, according to one embodiment, a normalization algorithm is
the process that translates the raw data for a set of microarrays
into measure of concentration in each sample. A survey of methods
for normalization is found in Gentleman, et al. For example, a
microarray chip assesses the amount of mRNA in a sample for each of
tens of thousands of genes. The total amount of mRNA depends both
on how large the sample is and how aggressively the gene is being
expressed. To compare the relative aggressiveness of a gene across
multiple samples requires establishing a common baseline across the
samples. Normalization allows one, for example, to measure
concentrations of mRNA rather than merely raw amounts of mRNA.
[0098] "Biologically homogeneous" refers to the distribution of an
identifiable protein, nucleic acid, gene or genes, the expression
product(s) of those genes, or any other biologically informative
molecule such as a nucleic acid (DNA, RNA, mRNA, iRNA, cDNA, etc.),
protein, metabolic byproduct, enzyme, mineral, etc., of interest
that provides a statically significant identifiable population or
populations that maybe correlated with an identifiable disease
state of interest.
[0099] "Low expression," or "low expression level(s)," "relatively
low expression," or "lower expression level(s)" and synonyms
thereof, according to one embodiment of the invention, refers to
expression levels, that based on a mixture model fit of density
distribution of expression levels for a particular multi-state gene
of interest falls below a threshold c, whereas "high expression,"
"relatively high," "high expression level(s)" or "higher expression
level(s)" refers to expression levels failing above a threshold c
in the density distribution. The threshold c is the value that
separates the two components or modes of the mixture model fit.
[0100] The practice of the present invention will employ, unless
otherwise indicated, conventional techniques of molecular biology
(including recombinant techniques), microbiology, cell biology, and
biochemistry, which are within the skill of the art. Such
techniques are explained fully in the literature, such as,
"Molecular Cloning: A Laboratory Manual", 2nd edition (Sambrook, et
al., 1989); "Oligonucleotide Synthesis" (M. J. Gait, ed., 1984);
"Animal Cell Culture" (R. I. Freshney, ed., 1987); "Methods in
Enzymology" (Academic Press, Inc.); "Handbook of Experimental
Immunology", 4th edition (D. M. Weir & C. C. Blackwell, eds.,
Blackwell Science Inc., 1987); "Gene Transfer Vectors for Mammalian
Cells" (J. M. Miller & M. P. Calos, eds., 4th edition);
"Current Protocols in Molecular Biology" (F. M. Ausubel, et al.,
eds., 1987); and "PCR: The Polymerase Chain Reaction", (Mullis, et
al., eds., 1994). The term "individual" or "individuals" is meant
to designate a mammal. Preferably, the mammal is a human being such
as a patient.
[0101] The term "healthy individual" or "healthy individuals" is
meant to designate individual(s) not diseased of colorectal adenoma
and/or colorectal carcinoma. That is to say, the term "healthy
individual(s)" is used only in respect of the pathological
condition of colorectal adenoma and/or colorectal carcinoma and
does not exclude the individual to suffer from diseases other than
colorectal adenoma and/or colorectal carcinoma.
[0102] The term "derivative thereof" is meant to describe any
modification on DNA, mRNA or protein level comprising, e.g., the
truncated gene, fragments of said gene, a mutated gene, or modified
gene. The term "gene" includes nucleic acid sequences, such as DNA,
RNA, mRNA or protein sequences or oligopeptide sequences or peptide
sequences. The derivative can be a modification which is an result
of a deletion, substitution or insertion of the gene. The gene
modification can be a result of the naturally occurring gene
variability. The term "naturally occurring gene variability" means
modifications which are not a result of genetic engineering. The
gene modification can be a result of the processing of the gene or
gene product within the body and/or a degradation product. The
modification on protein level can be due to enzymatic or chemical
modification within the body. For example the modification can be a
glycosylation or phosphorylation or farnesylation. Preferably, the
derivative codes for or comprises at least 5 amino acids, more
preferably 10 amino acids, most preferably 20 amino acids of the
unmodified protein. In one embodiment the derivative codes for at
least one epitope of the respective protein.
[0103] The term "patient" as used in the present application covers
humans as well as non-human beings such as animals. The animals are
preferably selected from the group consisting of rodents, e.g.,
mouse, rat, hamster, and other animals, e.g., guinea-pig, rabbit,
hare, dog and pig.
[0104] These animals can be used to specifically induce certain
disease states, like colorectal adenoma and colorectal carcinoma,
for research purposes. The induction of said disease states can,
for example, be effected by treatment of the animals, for example,
with radioactive or chemical substances known to induce colorectal
cancer or colorectal adenoma disease state. The disease states can
also be induced using viral transfection systems. It is also
possible to use genetically modified animals, in which one or more
specific gene function(s) has/have been altered, or knock-out
animals such as knock-out mice in which a specific gene function
has been deleted.
[0105] The term "compound" can be one or more chemical substances,
an antibody, protein, peptide, antisense mRNA, small molecular
drug, or combinations thereof. The compound can also be replaced by
irradiation, e.g., X-ray, or combinations of compounds and
radiation can be used.
[0106] A good prognosis may be defined as a prognosis in which a
patient is determined to be unlikely to benefit from cancer
treatment such as chemotherapy or radiation, for example,
subsequent to a colon cancer surgical procedure. This may be the
case where the expression level of the identified bimodal gene or
combination of genes for LCC or RCC disease is negatively
correlated with mortality.
[0107] A poor prognosis patient is used to define a patient that is
likely to benefit from further cancer treatment such as
chemotherapy or radiation, for example, subsequent to a colon
cancer surgical procedure. This may be the case where the
expression level of the identified bimodal gene or combination of
genes for LCC or RCC disease is positively correlated with
mortality.
Example 1
Identification of RT-PCR Primer-Probes that Measure in FFPE Tissue
the mRNA Species Targeted by the ap-Colon Microarray Probes
[0108] mRNA will be extracted from a number of colon cancer cell
lines as well as from paraffin (FFPE) blocks prepared from these
cell lines. This will enable direct assessment of the probes in the
FFPE material and comparison with the "fresh state". Initial
assessment will be performed using 13 different assay primer-probes
pairs (8 from ap-Colon (two per gene) and 5 normalization
controls). All assays will be performed in triplicate. The probes
will be verified as providing comparable results in fresh tissues
(cell lines) and matched FFPE counterparts. Quantitative RT-PCR
with .DELTA..DELTA.CT methods for data analysis will be used to
assess the utility of the probes. If suitable primer-probes cannot
be found for the initial choice of genes, the list will be screened
to identify replacement genes found in the development of ap-Colon.
The RL-COLON pair of tests will use the primer-probes identified
here.
[0109] Obtain archival FFPE colon cancer samples with data on
disease stage and 5-year survival outcome. 50-100 samples from the
right colon and the left colon will be obtained.
[0110] Use RL-COLON to verify differential expression of each gene
in the panel in archival colon cancer tissue with varying stages.
The tissue obtained will be divided in training and validation
sets. The training set will be used to find thresholds between high
and low expression levels of the genes in RL-COLON, replacing the
thresholds in the microarray-based ap-Colon. The validation set is
used to verify that RL-COLON is sufficiently predictive and
prognostic to guide treatment decisions.
[0111] The pathway to relapse, metastasis and eventual death
followed in a particular form of cancer is of fundamental concern
in both cancer biology and treatment. Methods of stratifying breast
cancer patients according to relapse risk have been developed using
multi-gene measures of mRNA concentrations.sup.9,10. These tests
measure the expression levels of numerous genes in the primary
tumor and partition tumors into a poor prognosis group that is
likely to metastasize, and a good prognosis group that is largely
relapse-free. This work was framed around the clinical problem of
identifying those patients who can avoid adjuvant chemotherapy with
no significant increased risk of metastasis.
[0112] Several authors have proposed prognostic signatures for
colon cancer.sup.11,12,13. However, none of these tests has the
prognostic power seen in the breast cancer tests, and they are of
questionable clinical value. While not intending to be bound by any
particular theory or mechanism of action, the failure to find an
effective panel of genes may be due, at least in part, to the
existence of multiple disease subtypes that follow different
pathways to progression.
Example 2
Materials and Methods
[0113] The present example is provided to present the various
materials, methods and statistical tools employed in the
development and practice of the present invention.
[0114] Statistical analysis. The language R
http://www.r-project.org/ was used for all statistical analyses.
Survival models were fit with the R package survival. The
microarray annotation package hgu133plus2.db in BioConductor
http://www.bioconductor.org/ was also used. The proportional hazard
condition was verified with the cox.zph function. All p-values in
survival models refer to the p-value of the logrank score of a Cox
proportional hazard model (CPH). A CPH is considered statistically
significant if the p-value of the logrank score is <0.05.
[0115] Microarray dataset of colon cancer samples. In the present
examples, the Gene Expression Omnibus
(http://www.ncbi.nim.nih.gov/gds) data series GSE14333 was
used..sup.13 The characteristics of the data series GSE14333 are
provided in Table 3.sup.23.
[0116] Sample Preparation: The samples examined were colorectal
cancer specimens from the H. Lee Moffit Cancer Center in the United
States and Royal Melbourne Hospital, Western Hospital, and Peter
MacCallum Cancer Center in Australia. Surgically isolated
colorectal cancers were immediately frozen in liquid nitrogen.
Total RNA was extracted from cancer tissue using Trizol reagent
(Invitrogen). Approximately 8 micrograms of total RNA was processed
to produce biotinylated cRNA targets.
[0117] After preparation, the samples were hybridized to Affymetrix
GeneChip.RTM. hgu133plus 2 arrays. Expression values are computed
from the CEL files with gcrma.sup.13. The survival endpoint
reported in GSE14333 is any relapse, distant or local. Since the
third quartile of time to relapse in the dataset is 28 months, the
relapse data was censored to 60 months in the present examples. No
further follow-up was available on the Dukes stage D samples. The
characteristics of the tumors in the dataset are summarized in
Table 3. More complete information about the patients is found in
Jorisson, et al., (2008).sup.13.
[0118] KEGG pathway analysis. The Kyoto Encyclopedia of Genes and
Genomes (KEGG) http://www.genome.ip/kegg/kegg2.html identifies the
component genes in selected pathways. The BioConductor package
hgu133plus2.db is used to associate array probes with pathways.
[0119] Multistate survival models. In Buechler, et al..sup.2, a
method of defining survival models based on gene expression data is
presented. In this system, an array probe (gene) is called
multistate if the probe's expression values naturally divide
samples into two distinct subtypes, much like the bimodality of the
ESR1 gene divides samples into ER+ and ER- subgroups. For a
multistate probe p there is a threshold c such that the samples
with expression values above c, denoted p+, form one component, and
the samples with expression values below c, denoted p-, form the
second component. In the multistate probes that arise in survival
models in cancer, one of the components is approximately normally
distributed with a narrow variance, and the other smaller component
is a tail to the right or left. Many genes have nearly normal
expression distributions, hence are not considered multistate. The
precise definition of a multistate probe is given in Buechler, et
al..sup.2
[0120] Colorectal cancer often develops through a specific genetic
progression'.sup.7. In the multistate genes that model the
progression of cancer, one of the components is highly enriched in
poor prognosis patients. To further exploit the principle that a
multistate probe represents distinct states, the expression vector
for a multistate probe is replaced by a binary variable which is 0
in the component of good prognosis samples and 1 in the poor
prognosis component. Here, the significance of a multistate probe
in a survival model is measured by the p-value of a logrank score
of a Cox proportional Hazard Model (abbreviated CPH) using only the
probe's binary variable.
[0121] Cell Culture. Colorectal cancer cell lines HCT-116, HT29,
SW480, SW620 and SW837 were purchased from the American Type
Culture Collection (ATCC; Manassas, Va.) and were maintained in
RPMI 1640 medium (Invitrogen, Gaithersburg, Md.) containing 10%
fetal bovine serum (Thermo Scientific, Pittsburgh, Pa.) and 2 mM
L-glutamine (Invitrogen, Gaithersburg, Md.) and grown in 5%
CO.sub.2 at 37.degree. C.
[0122] NOX4 silencing by siRNA. At 50-60% confluence, SW620 cells
were transfected with one of two siRNA oligonucleotides targeting
the NOX4 transcript. The sequences are referred to in the text as
siRNA NOX4.sub.--5 and siRNA NOX4.sub.--8 and correspond with the
following sequences:
TABLE-US-00003 5'-CCAGGAGAUUGUUGGAUAATT-3' - siRNA NOX4_5; and
5'-GAGUUUCCAUAGGGAACUATT-3' - siRNA NOX4_8,
[0123] respectively. The oligo AllStar negative control siRNA was
used was used as a negative control and the oligo All Star Death
was used as a positive control siRNA to assess transfection
efficiency. All siRNAs used were obtained from Oiagen Inc.
(Germantown, Md.). For cell viability studies, each siRNA (2 pmol)
was added to individual wells in a 96-well plate in 25 .mu.L of
serum-free RPMI and complexed with 0.5 .mu.L Oligofectamine
transfection reagent (Invitrogen, Gaithersburg, Md.) in 25 .mu.L of
serum-free RPMI. The resulting mixture was allowed to complex for
30 min at ambient temperature. Next, SW620 cells (5000 cells/well)
were added in 50 .mu.l RPMI supplemented with 20% FBS to yield
transfection mixtures consisting of 20 nM siRNA in RPMI with 10%
FBS. The final mixture was incubated at ambient temperature for 45
min before being placed in an incubator in 5% CO.sub.2 at
37.degree. C. For analysis of mRNA and ROS production,
transfections were performed as described above except that they
were conducted in 6-well plates and all reagent amounts were scaled
up 30-fold. For characterization studies, each siRNA was evaluated
by comparing cell viability, mRNA or ROS levels with those found in
cells transfected with negative-control siRNA. siRNA knockdown was
validated using real-time PCR.
[0124] Cell viability assay. As a surrogate marker for cell
viability, the reduction of resazurin to resorufin was measured in
transfected cells using the Cell Titer-Blue Cell Viability assay
(Promega, Madison, Wis.). Triplicate transfections for each siRNA
duplex were set up in a 96-well plate at a concentration of 5,000
cells/well. After 72 and 96 hr, 204 of CellTiter-Blue reagent was
placed in each well and incubated for 1 hr. Reduction of resazurin
to resorufin, read as fluorescence emission (560Ex/590Em) was
measured using a plate reader (Spectramax M5, Molecular Devices,
Sunnyvale, Calif.). Viability of transfected cells was compared
with cells transfected with the negative control siRNA. Additional
cells transfected with Qiagen's All Star Death control were used as
a positive control.
[0125] Gene expression analysis. Total RNA was extracted from SW620
cells transfected with siRNA NOX4.sub.--5, siRNA NOX4.sub.--8 and
control siRNA 48 hr post-transfection using RNeasy Mini kit
(Qiagen, Germantown, Md.), following the animal cell protocol and
homogenizing via 20 gauge needles. Normal human colon RNA isolated
postmortem from a donor was purchased from Ambion (Applied
Biosystems, Foster City, Calif.). Nucleic acid quantity, quality
and purity were determined using a Nanodrop 2000 UV-VIS
spectrophotometer (Nanodrop, Rockland, Del.). cDNA was generated
using the High-Capacity Reverse Transcriptase cDNA kit (Applied
Biosystems, Foster City, Calif.) and 1.0 .mu.g of total RNA
according to the manufacturer's instructions. Quantitative PCR
reactions were performed using the following primer sequences
(Operon, Huntsville, Ala.): hypoxanthine phosphoribosyltransferase
1
(HPRT1), HPRT1 For
5'-GCCATGAAGCAGGACTCTAAAGA-3' and
HPRT1 Rev
5'-TTGGCATAACACAGCTGATTGAT-3';
NOX4 For
5'-ATGTCAGTTGCTGCATTCCTAA-3' and
NOX4 Rev
5'-TCACTCAATAGTGCTGTGGTTT-3'.
[0126] Quantitative PCR was performed with a real-time PCR system,
StepOnePlus (Applied Biosystems, Foster City, Calif.). Reactions
were conducted with 300 ng of cDNA, in a final volume of 25 .mu.L.
The PCR mixture contained SYBR Green (Applied Biosystems, Foster
City, Calif.) and 0.6 nmol of each primer (forward and reverse).
The levels of transcripts were quantified using the comparative CT
method relative to levels of hypoxanthine phosphoribosyltransfease
(HPRT1). All samples were analyzed in triplicate wells with the
median of each measurement used for CT calculations.
[0127] Measurement of Superoxide Production. SW620 cells were
assayed for superoxide production 48 hr post transfection with
siRNA NOX4.sub.--5, siRNA NOX4.sub.--8 or negative control siRNA.
Transfected cells were washed with phosphate-buffered saline
(Invitrogen, Gaithersburg, Md.) and collected into a centrifuge
tube. Superoxide production was measured by chemiluminescence with
DIOGENES (National Diagnostics, Atlanta, Ga.), a
superoxide-specific, luminol-based detection system, according to
the manufacturer's instructions. Measurements were performed in
96-well microtiter chemiluminescence plates (5.times.10.sup.4 cells
per well). The total integrated light units recorded (Spectramax
M5, Molecular Devices, Sunnyvale, Calif.) from siRNA NOX4
transfected cells were compared to those recorded in cells
transfected with negative-control siRNA.
Example 3
Different Pathways dominate Progression to Relapse in LCC and
RCC
[0128] The present example demonstrates the location specificity of
the dominant pathway to relapse in colon cancer. Attention is
focused on samples in GSE14333 with Dukes stage A, B or C. Table 3
demonstrates the characteristics of patients in GSE14333.
TABLE-US-00004 TABLE 3 Characteristics of patients in GSE14333
relapse chemo in stage in stage Dukes stage gender A, B, C A, B, C
no. (A/B/C/D) (M/F) (no/yes) (no/yes) all tumors 290 44/94/91/61
164/126 180/46 142/87 left side 122 18/37/40/27 77/45 70/23 55/40
right side 125 17/44/41/23 59/66 84/17 63/39 rectum 39 8/12/10/9
26/13 24/6 22/8 other 4 1/1/0/2 2/2 2/0 2/0
TABLE-US-00005 TABLE 4 Genes and associated pathways most
significantly implicated in relapse in left side colon cancer with
Dukes stage A, B or C. Left side: CPH direction pathways multistate
probe gene p-value in relapse effected* marker 236028_at IBSP 2.7
.times. 10.sup.-5 UP FA NOX4 210095_s_at IGFBP3 1.0 .times.
10.sup.-4 UP P53 NOX4 213425_at WNT5A 2.5 .times. 10.sup.-4 DOWN
WNT MMP3 223121_s_at SFRP2 3.1 .times. 10.sup.-4 UP WNT NOX4
229271_x_at COL11A1 7.1 .times. 10.sup.-4 UP FA NOX4 216442_x_at
FN1 7.3 .times. 10.sup.-4 UP FA NOX4 220088_at C5AR1 1.4 .times.
10.sup.-3 UP CCC NOX4 201109_s_at THBS1 1.9 .times. 10.sup.-3 UP
P53, TGFB, NOX4 FA 202627_s_at SERPINE1 2.7 .times. 10.sup.-3 UP
P53, CCC NOX4 212607_at AKT3 2.9 .times. 10.sup.-3 UP FA, INS NOX4
221729_at COL5A2 3.3 .times. 10.sup.-3 UP FA NOX4 203083_at THBS2
3.6 .times. 10.sup.-3 UP TGFB, FA NOX4 204315_s_at GTSE1 5.8
.times. 10.sup.-3 DOWN P53 MMP3 210511_s_at INHBA 6.2 .times.
10.sup.-3 UP TGFB NOX4 202310_s_at COL1A1 6.4 .times. 10.sup.-3 UP
FA NOX4 202833_s_at SERPINA1 6.5 .times. 10.sup.-3 DOWN CCC
MMP3
TABLE-US-00006 TABLE 5 Genes and associated pathways most
significantly implicated in relapse in right side colon cancer with
Dukes stage A, B or C. Right side. 202267_2_at LAMC2 3.7 .times.
10.sup.-7 UP FA CDX2 236313_at CDKN2B 8.9 .times. 10.sup.-6 UP CC,
TGFB CDX2 203725_at GADD45A 1.7 .times. 10.sup.-5 UP CC, P53 CDX2
204420_at FOSL1 2.0 .times. 10.sup.-5 UP WNT FAM69A 202628_s_at
SERPINE1 8.7 .times. 10.sup.-5 UP P53, CCC CDX2 203323_at CAV2 1.6
.times. 10.sup.-4 UP FA CDX2 201124_at ITGB5 1.7 .times. 10.sup.-4
UP FA FAM69A 213792_s_at INSR 1.8 .times. 10.sup.-4 UP INS CDX2
202627_s_at SERPINE1 1.9 .times. 10.sup.-4 UP P53, CCC CDX2
203726_s_at LAMA3 2.2 .times. 10.sup.-4 UP FA CDX2 208711_s at
CCND1 2.4 .times. 10.sup.-4 UP CC, P53, FAM69A WNT, FA 208613_s_at
FLNB 3.3 .times. 10.sup.-4 UP FA FAM69A 201925_s_at CD55 3.4
.times. 10.sup.-4 UP CCC CDX2 214866_at PLAUR 3.4 .times. 10.sup.-4
UP CCC FAM69A 204714_s_at F5 4.7 .times. 10.sup.-4 UP CCC CDX2
204363_at F3 5.4 .times. 10.sup.-4 UP CCC CDX2 *CC = cell cycle,
CCC = complement and coagulation cascades, FA = focal adhesion, INS
= insulin signaling, P53 = p53 signaling, TGFB = TGF.beta.
signaling, WNT = Wnt signaling.
[0129] Among the most significant genes in the left-side analysis
is wingless-type MMTV integration site family, member 5A (WNT5A),
which is down regulated in the samples that will relapse. Secreted
frizzled-related protein 2 (SFRP2), which competes with the Wnt
proteins for the Frizzled receptor, is up regulated. Also, the
frizzled receptor, frizzled homolog 3 (FZD3), is down regulated in
the relapse cases. These expression changes point to a reduction in
Wnt signaling in the left-side tumors. There are no such
indications in the relapse cases on the right side. Axin2 is down
regulated in the relapse cases on the right side, reducing
transcriptional inhibition by .beta.-catenin.
[0130] The most striking feature of relapse on the right side is
elevated expression of cyclin-dependent kinase inhibitor 2B (p15,
CDKN2B), growth arrest and DNA-damage-inducible, alpha (GADD45A)
and cyclin D1 (CCNDJ) in the relapse cases. This points to a strong
proliferation signal in the right side tumors, of which there is no
such indication on the left side. Genes involved in p53 signaling
are altered on both sides, although more so on the right side.
There are 30 probes from the selected pathways significantly
implicated in relapse on both sides. These common probes are
largely involved in focal adhesion, plus activity of serpin
peptidase inhibitor, Glade E (nexin, plasminogen activator
inhibitor type 1), member 1 (SERPINE1), plasminogen activator,
urokinase (PLAU) and plasminogen activator, urokinase receptor
(PLAUR) in cell adhesion and migration.
Example 4
Single Genes are Strongly Predictive of Relapse in Left-Side and
Right-Side Tumors and Encapsulate Pathway Activity
[0131] The multistate methodology is applied separately to the
left-side tumors and the right-side tumors to identify multistate
probes that are significantly predictive of relapse. These panels
of few genes also act as biomarkers for the pathways to progression
described in the preceding section.
[0132] Application of the multistate methodology to the left-side
tumors with Dukes stage A, B or C identifies 219773_at (NOX4) as
one of the most significant predictors of relapse. The distribution
of NOX4 in the left-side tumors shows a large component with low
mean expression and narrow variance, and a right tail of elevated
expression (FIG. 1(a)). The multistate methodology divides the two
components at the expression value 3.0. As the boxplot in FIG. 1(b)
shows, there is a strong correlation between elevated NOX4
expression and relapse within 5 years. NOX4 expression is
summarized as a binary variable by assigning 1 to every sample with
expression level above the cut value (the NOX4+ component), and 0
for the other samples (NOX4-). (The component enriched with poor
prognosis patients is assigned the value 1.) The Kaplan-Meier
survival curve for the binary NOX4 variable (FIG. 1(c)) shows the
prognostic power of this variable in the left-side tumors. The
predictive power of NOX4 on the right-side tumors is reported in
FIG. 1(d). NOX4 has a distinctly lower significance on the right
side.
[0133] Low expression of the probe 2 0 6 3 8 7_at (CDX2) is highly
predictive of relapse in the right-side tumors (FIG. 2(b)). FIG.
2(a) illustrates the partition of the right-side samples into low
(CDX2-) and high (CDX2+) components. The survival characteristics
of the binary CDX2 variable in the right-side tumors and the
left-side tumors are reported in FIG. 2(c,d).
[0134] In addition to NOX4, matrix metallopeptidase 3 (stromelysin
1, progelatinase) (MMP3) is a multistate gene that is predictive of
relapse in left-side tumors. In this case, the low component is
enriched with relapse cases. A CPH with a binary variable
representing the MMP3+/- components has a p-value
3.86.times.10.sup.-6. NOX4 and MMP3 provide independent information
about relapse since the poor prognosis components defined by the
two genes have few cases in common. In the right-side tumors, the
high component of family with sequence similarity 69, member A
(FAM69A) is enriched with relapse cases not identified by CDX2.
[0135] In addition to separating the population of left side colon
cancer disease apart from right side colon cancer disease
prognosis, the multistate genes capture the pathogenic effects of
the genes listed in Table 4 and Table 5 hence, the pathways
containing these genes. For example, the most significant gene in
the left-side analysis is integrin-binding sialoprotein (IBSP). The
NOX4+ component, in addition to containing the samples with
elevated NOX4 expression contain the samples with elevated IBSP
expression. Assessing the relationship quantitatively, a t-test for
the mean expression value of IBSP in NOX4+ versus NOX4- has a
p-value of 1.38.times.10.sup.-5. A CPH using IBSP expression as the
variable, restricted to NOX4-, is not statistically significant,
since the NOX4- component contains almost no samples with elevated
expression of IBSP. In this way, IBSP can be replaced by NOX4 in a
survival model. The multistate gene MMP3 similarly represents the
next most significant gene, WNT5A. In Table 4 and Table 5, for each
probe, the multistate gene is identified that separates the gene's
expression into high and low components in a statistically
significant manner. On the right side, CDX2 effectively represents
almost all of the probes listed in Table 5.
[0136] Tests that monitor only NOX4 would not be capable of
distinguishing LCC from RCC disease. The ability to distinguish LCC
from RCC disease is possible here because of measuring expression
levels of CDX2. The inclusion of additional probes for CDX2 and/or
FAM69A, as identified in Table 5, provides a much more robust
analysis, and corrects an otherwise incorrect diagnosis of a colon
cancer patient as at "low risk" for recurrent colon cancer relapse.
Specifically, because patients with RCC do not have low expression
levels of NOX4, (below normal, non-cancerous tumor tissue), such
patient tissue samples would be erroneously identified as "good
prognosis" patients, with a good indication of colon cancer free
survival. Only by first being able to identify a patient as having
RCC rather than LCC disease, and then taking the next step of
examining these right side colon tumor patient tissue for
expression of, especially CDX2, can otherwise false negative (false
"good prognosis") patients be identified and proper clinical
protocol be determined.
[0137] For patients with RCC disease, this test is especially
critical, and provides an entirely new prognostic tool, especially
since NOX4 is not among the genes found to be differentially
expressed in this pathology. Genetic probes for NOX4 are therefore
of little to no utility in the accurate prognosis on RCC. Tests
that only measure NOX4 expression would be incapable of accurately
identifying poor prognosis patients that may have right-side or
left-side disease. For a set of LCC samples, 89% of the patients
identified as good prognosis by NOX4 will be free of relapse for 5
years (legend of FIG. 1(c)), resulting in an about 11%
misclassification rate. However, for a set of RCC samples, 82% of
the patients identified as good prognosis by NOX4 will be free of
relapse for 5 years (legend of FIG. 1(d)), meaning a higher
percentage, about 18%, are misclassified as good prognosis, and
contrary to an initial good prognosis, later relapse. On the other
hand, if CDX2 is used as a prognostic test for RCC samples, the
misclassification rate is only 12% (legend of FIG. 2(c)). Thus,
viewing these results over both LCC and RCC, using only NOX4 as a
prognostic test, a false identification rate of 14.5% exists among
the samples characterized as good prognosis. A test that uses NOX4
for LCC samples and CDX2 for RCC samples has a much lower
misclassification rate of 11.5%. This is a statistically and
medically significant improvement in prognostic power.
Example 5
NOX4 mRNA Interference with siRNA in Colon Cancer (SW620) Cells
Reduces Superoxide Production Levels without Affecting Cell
Viability
[0138] The present example demonstrates the utility of the present
invention for treating left-side colon cancer disease through
targeted reduction of colon cancer cell superoxide production.
Because elevated NOX4 is identified as being prognostic of a high
probability of colon cancer disease relapse in left colon cancer
disease, it is proposed that this model may be used to identify and
screen for pharmaceutical agents useful in the improved treatment
of patients identified to have left-side colon cancer disease.
[0139] Overproduction of reactive oxidative species (ROS) has long
been recognized as a risk factor in carcinogenesis. To further
investigate NOX4 function in colon cancer, superoxide production
was measured by the chemiluminescent method for SW620 cells. SW620
cells are a lymph-node metastasis colon adenocarcinoma cell line.
NOX4 is shown to be expressed in this cell line, and the present
example demonstrates that application of NOX4 siRNA causes a
significant reduction in ROS production. Expression of NOX4 (mRNA
levels) was examined in four cell lines: HT29, HCT 116, SW480 and
SW620, the patient-matched lymph-node metastasis to SW480 (Dukes
stage B). NOX4 inhibition with RNA interference in SW620 cells was
found to be associated with a decrease in superoxide producing
activities of the cells as indicated by the reduced ROS production
(FIG. 5).
[0140] Cell lines derived from primary adenocarcinoma or carcinoma
colon tumors (HCT116, HT29 and SW480) were found to have NOX4
expression levels below or comparable to normal, non-cancerous
colon NOX4 levels. However, NOX4 expression was found to be greatly
elevated in an adenocarcinoma cell line SW620 compared to normal
colon (See FIG. 3). The adenocarinoma cell line SW620 was derived
from the lymph metastatic site (SW620).
[0141] To investigate NOX4 function in metastatic SW620 cells, the
affect of NOX4 on cell viability was examined. NOX4 expression was
silenced using RNAi interference by transfecting SW620 cells with
oligonucleotides targeting the NOX4 transcript. Similar cell
viability was observed between NOX4 silenced cells and negative
control cells as reported in FIG. 4. Therefore, targeted NOX4
knockdown does not seem to affect cell viability.
[0142] To further investigate NOX4 function in SW620 cells,
superoxide production was assayed by the chemiluminescent method.
NOX4 inhibition with RNA interference in these SW620 cells was
found to be associated with a decrease in superoxide producing
activities of the cells, as indicated by the reduced ROS production
(FIG. 5).
Example 6
Left-Side Colon Carcinogenesis and Disease Progression and
Right-Side Colon Carcinogenesis and Disease Progression
[0143] The microarray dataset GSE14333 analyzed here demonstrates
that disease progression in RCC is dominated by elevated Wnt
signaling and elevated proliferation, most strongly indicated by
elevated levels of CCND1 in the relapse cases. Up regulation of
CCND1 is accompanied by increased expression of the pro-apoptotic
gene GADD45A and elevation of the growth arrest gene CDKN2B. Thus,
these tumors that have not yet metastasized may be in a cycle of
rapid mitosis and apoptosis. The GSE14333 dataset is different from
other datasets, such as GSE12945, GSE17536, GSE17537. The cohort
GSE14333 contains the patients in GSE17536, GSE17537, but it also
contains samples not studied earlier.
[0144] In LCC progression to relapse is characterized by reduced
Wnt signaling and, paradoxically, elevated expression of the
anti-angiogenic genes thrombospondin 1 (THBS1) and SERPINE1. The
data present fewer clear indications of the route to relapse in
LCC.
[0145] In a pancreatic cancer cell line, inhibition of NOX4
activates apoptosis via the AKT-ASK1 cell survival pathway.sup.19.
In the present example, NOX4 inhibition in SW620 shows no decrease
in cell viability. However, reduction of NOX4 expression via
siRNA-mediation corresponds to a significant reduction in ROS
production in the SW620 cells. This finding suggests that NOX4 is a
novel source of ROS production in metastatic and pre-metastatic
colon cancer.
[0146] From this data, it is reasoned that if NOX4 exerts
cancer-promoting effects, it is most likely at more advanced tumor
stages, as NOX4 expression is comparable to normal colon levels in
primary adenocarcinoma and carcinoma derived cell lines and above
normal colon levels in the metastatic cell line, SW620 (FIG.
3).
[0147] In renal cell carcinoma, NOX4 is critical for HIF2-alpha
transcriptional activity.sup.20. Specifically, inhibition of NOX4
decreases HIF2-alpha production. In the left-side colon cancer
samples microarray data, there was no change in HIF2-alpha
expression between the NOX4- and NOX4+ component. A change in
hypoxia-related gene expression that was identified was a small
decrease in HIG1 hypoxia inducible domain family, member 1A and
HIG1 hypoxia inducible domain family, member 2A expression in NOX4+
over NOX4-. The results in Table 4 show that NOX4 expression is
central to the progression of LCC.
[0148] Low expression of MMP3 is also implicated in left-side colon
cancer disease progression. MMP3 is a member of the matrix
metalloproteinases family of extracellular proteinases that mediate
many of the changes in the tumor microenvironment during cancer
progression.sup.26. The genes correlated to MMP3 in expression (see
Table 4) point to a significant role for reduced Wnt signaling in
left-side disease progression. WNT5A is a known tumor-suppressor
whose promoter is frequently methylated in colorectal
cancer.sup.21. In contrast, Wnt signaling is apparently elevated in
the right-side colon cancer relapse cases.
[0149] In RCC, low expression of CDX2 is strongly associated with
relapse. CDX2 acts as a transcription factor, initially expressed
during embryogenesis in the development of the small intestine and
colon, and regulating a diverse range of functions from
proliferation, cell-cycle arrest, differentiation, and
apoptosis.sup.22. In healthy adult colon tissue, CDX2 is expressed
throughout the colon and regulated post-translationally through
phosphorylation. With carcinogenesis, expression patterns of CDX2
are altered. Analysis of 65 colorectal tumors mapping CDX2
expression throughout the colon and rectum found significantly
lower expression of CDX2 in 37 right-sided, poorly differentiated
tumors as compared to 28 left-sided tumors.sup.23. Methylation of
the CDX2 promoter has been proposed as a mechanism for
down-regulation in colorectal carcinomas.sup.24. CDX2 inhibits the
Wnt signaling pathway, through reduction of the tyrosine
phosphorylation of .beta.-Catenin, resulting in decreased T-cell
factor signaling and cell proliferation.sup.27. With the reduced
expression of CDX2 that accompanies carcinoma, it has been
described as functioning in a tumor-suppressor role. In addition,
CDX2 regulates E-cadherin trafficking to the cell
membrane.sup.28.
[0150] FAM69A is located at 1p22.1, a genomic region that is
preferentially deleted in microsatellite stable colon
tumors.sup.25. A locus of genes in this region, including FAM69A,
contains single nucleotide polymorphisms that increase the risk of
multiple sclerosis.sup.29. Expression patterns of the genes in this
region do not show signs of deletion in the microarray data used
here. The mechanism by which FAM69A expression is correlated with
relapse risk remains an open problem for future study.
[0151] It has previously been proposed that the differences in
survival between RCC and LCC could be the results of any number of
causes, for example difference in time of detection, embryologic
origin, exposure to fecal matter or genetics.sup.3. Regardless of
the underlying cause, different mechanisms dominate progression of
RCC and LCC, establishing that they should be treated as different
diseases. The prominent role of NOX4 as a prognostic biomarker in
LCC makes it a important target for this cancer biology and LCC
specific therapeutics.
Example 7
Genomic Test for Separating Right-Side Colon Cancer (RCC) from
Left-Side Colon Cancer (LCC) with a High Degree of Accuracy
[0152] Expression levels of the gene prostate cancer susceptibility
candidate (PRAC) can be used to accurately estimate the location of
origin of a colon tissue sample. Using microarray data from
GSE14333 and the array probe 230784_at for PRAC, 91% of right-side
colon samples are shown to have negligible expression levels of
PRAC, while 79% of left-side colon samples have positive expression
levels of PRAC.
[0153] As used herein, a positive expression level of a gene, such
as PRAC, is defined as having a detectable expression level by
quantitative RT-PCR. A negligible expression level of a gene, such
as PRAC, is defined as not having a detectable level of expression
by quantitative RT-PCR.
[0154] A colon tumor sample that positively expresses the gene PRAC
is very likely to be a left-side sample. A colon tumor sample that
has negligible expression of the gene PRAC is very likely to be a
right-side sample.
Prophetic Example 8
RCC and LCC Prognostic Colon Cancer Test for Clinical Use with FFPE
Specimens
[0155] Common practice in clinical pathology is to preserve a solid
tumor tissue sample in formalin and fix it in paraffin. This sample
is examined under a microscope in the process of establishing the
tumor stage and it is readily available for staining with protein
antibodies or analysis of DNA. Any widely used diagnostic test
using colon tumor samples must be applicable to formalin-fixed,
paraffin-embedded (FFPE) tissue.
[0156] Translating a genomic prognostic test developed with
microarrays to one that uses FFPE tissue faces the following
difficulty. Fixing tissue in formalin is known to degrade some
species of mRNA. For this reason, analyses that measure the entire
genome of mRNA species, such as microarray analysis with Affymetrix
GeneChip arrays, require frozen tissue samples. The analysis of
microarray data that lead to the prognostic tests in this invention
used frozen tissue samples. If two samples recovered from the same
tissue block, one frozen and one prepared as an FFPE block, are
hybridized to whole-genome microarray, some of the mRNA species
will produce equivalent readings on both arrays and others will
show significantly reduced levels in the sample from FFPE
tissue.
[0157] The prognostic tests for LCC and RCC disclosed in this
invention uses one or more gene in its several embodiments,
however, no increased prognostic power is found with more than two
genes. The efficient method for measuring the expression levels of
few genes is quantitative RT-PCR. Thus, one version of the test
that could be used in a clinical setting will use RT-PCR to measure
several species in mRNA from an FFPE tissue source. Because some
mRNA species may be degraded in FFPE tissue, alternative tests will
be sought using probes found in Table 1 and Table 2. This
development process proceeds through the following two steps,
separately for LCC and RCC.
[0158] For each mRNA species in Table 1 and Table 2, look for
RT-PCR probes that yield equivalent measurement of the mRNA species
in frozen and FFPE preparations of the same colon tissue. The
identification of an RT-PCR probe is known to one skilled in the
art of molecular biology. The RT-PCR probe is an oligonucleotide of
15-60 nucleotides that hybridize with high specificity to the
targeted species of mRNA.
[0159] From the subset of genes in Table 1 and Table 2 for which
the first step was successful, develop a prognostic panel by the
following procedure. Using a test set of FFPE colon cancer samples
(RCC and LCC respectively) with known 5-year relapse status, select
as the first gene in the panel the one that is most significantly
prognostic. From the remaining genes, select the one such that the
intersection of its good prognosis component with the good
prognosis component of the first gene, is most significantly
prognostic among the alternatives. This process is continued until
further intersection with good prognosis components no longer
increases the prognostic significance.
Example 9
Computer Methods for Determining Relapse and Relapse Free
Probability in Colon Cancer Patients and Chemotherapy
Responsiveness
[0160] The present example is provided to demonstrate the utility
of the present method as a computerized method that may be used in
the practice of the invention.
[0161] Computerized Method for Determination of Relapse/Non-Relapse
in an LCC or RCC Patient Population:
[0162] In another aspect, the invention provides a computer
implemented method of determining relapse free survival probability
for a LLC or RCC patient having undergone colon cancer surgery. In
one embodiment, the computerized method comprises classifying the
colon cancer patient as a right side colon cancer (RCC) or as a
left side colon cancer (LCC) disease patient by identifying the
side of the colon on which the colon cancer was localized and
providing said identifying classification to a receiver module,
where the identifying classification of the patient is LCC disease,
measuring an expression level of an RNA transcript or expression
product of NOX4 in a colon cancer tissue obtained from the LCC
patient, to provide a test NOX4 test level, and where the
identifying classification of the patient is RCC disease, measuring
an expression level of an RNA transcript or expression product of
CDX2 in a colon cancer tissue obtained from the RCC patient, to
provide a test CDX2 level, and providing said expression level data
to a receiver module; and determining the relapse free survival
probability of the LCC patient as good in a LCC patient tissue with
a low NOX4 expression level, and a relapse-free survival
probability to a LCC patient as poor with a high NOX4 expression
level, and determining the relapse-free survival probability of an
RCC patient as poor in a RCC patient tissue with a low CDX2
expression level, and a relapse-free survival probability as good
with a high CDX2 expression level, wherein an expression level is
considered low or high as compared to a threshold value, wherein
said threshold value is calculated from a reference set of
like-gene expression levels from a like-classified colon cancer
patient population, said like-classified patient population
comprising relapse and relapse-free colon cancer patients.
[0163] In some embodiments, the method may further include a
computer implemented step wherein the module is directed to
generate a prognosis report of said LCC patient or RCC patient.
Computerized Method for Determination of Responsiveness or Lack of
Responsiveness to Chemotherapy in an LCC or RCC Patient
Population:
[0164] In another aspect, the some embodiments, the invention
provides a computer implemented method of determining the
probability that a LCC or RCC patient will not be responsive to
chemotherapy. In patients determined to have a low probability of
being responsive to chemotherapy, the patient may be excused from
chemotherapy after having undergone colon cancer surgery.
[0165] In one embodiment, the computer implemented method of
determining a probability of a lack of responsiveness to
chemotherapy treatment in a patient having had surgical
intervention for right side colon cancer (RCC) or left side colon
cancer (LCC), comprises classifying the colon cancer patient as a
right side colon cancer (RCC) or as a left side colon cancer (LCC)
disease patient by identifying the side of the colon on which the
colon cancer was localized and providing said identifying
classification to a receiver module, where the classification of
the patient is LCC disease, measuring an expression level of an RNA
transcript or expression product of NOX4 in a colon cancer tissue
obtained from the LCC patient, to provide a test NOX4 test level,
and where the identifying classification of the patient is RCC
disease, measuring an expression level of an RNA transcript or
expression product of CDX2 in a colon cancer tissue obtained from
the RCC patient, to provide a test CDX2 level, and providing said
expression level data to a receiver module; and determining the
likelihood of response to chemotherapy of the LCC patient as low in
a patient with a low NOX4 expression level; and determining the
likelihood of response to chemotherapy of the RCC patient as low in
a patient with a high CDX2 expression level.
[0166] As part of this method, an expression level is considered
low or high as compared to a threshold value, wherein said
threshold value is calculated from a reference set of like-gene
expression levels from a like-classified colon cancer patient
population, said like-classified patient population comprising
relapse and relapse-free colon cancer patients not having received
chemotherapy.
[0167] In some embodiments, the method may further include a
computer implemented step wherein the module is directed to
generate a prognosis report of said LCC patient or RCC patient.
Example 10
Prognostic Probes and Development Thereof for RCC and LCC
[0168] The various probes identified in Tables 2, 3, 4 and 5 were
employed in the various examples provided here, and found to render
robust and highly prognostic data concerning colon cancer relapse,
survival probabilities and expected likelihood of favorable
response to chemotherapy. In some embodiments, the particular gene
probes used are provided in Table 6. These particular probes are
commercially available.
TABLE-US-00007 TABLE 6 Probes LEFT-SIDE Probes 205828_at MMP3
NM_002422 #1 GAAAATCGATGCAGCCATTTCTGAT #2 TTTATTTCTTTACTGGATCTTCACA
#3 GATCTTCACAGTTGGAGTTTGACCC #4 TAATTCTTCACCTAAGTCTCTGTGA #5
ATTGAAATGTTCGTTTTCTCCTGCC #6 GTGACTCGAGTCACACTCAAGGGAA #7
TGAGCGTGAATCTGTATCTTGCCGG #8 GTATCTTGCCGGTCATTTTTATGTT #9
CAAATGGGCTGCTGCTTAGCTTGCA #10 TTAGCTTGCACCTTGTCACATAGAG #11
GGGGAAGCACTCGTGTGCAACAGAC 230748_at SLC16A6 AI873273 #1
GGTTACAGGTACACACAAGCTTGAA #2 TGTAGAGCATCTTATCAGCCATAGA #3
GGATGTAGCAAATCTCTGTCACTGC #4 CTCTGTCACTGCTTGAGAACTTTGA #5
GAGCTTGTGGCAGTTTTGCAGACTT #6 GACTTACATGACTTCAGCACTTTAC #7
AGCACTTTACGACATATTTTTTACT #8 ACTGATTTCTGAGGGATCTGCTCCA #9
ATCTGCTCCATGTCTATTCTGTTAT #10 GTATGCCAATTTCAGTATGTCAATA #11
GACATTCTGGTACTTCTAGATTTGC 205990_s_at WNT5A NM_003392 #1
ATCACCTCAGCCAACTGTGGCTCTT #2 CAACTGTGGCTCTTAATTTATTGCA #3
GCATAATGATATTCACATCCCCTCA #4 ACATCCCCTCAGTTGCAGTGAATTG #5
GATTGTTCCTTTTTAGTGACTCATG #6 GTTGAGTTTAACAATCCTAGCTTTT #7
AAATATTCTACATGTCATTCAGATA #8 ATTATGTATATCTTCTAGCCTTTAT #9
ATCTTCTAGCCTTTATTCTGTACTT #10 ACATATTTCTGTCTTGCGTGATTTG #11
GCGTGATTTGTATATTTCACTGGTT 202435_s_at CYP1B1 AU154504 #1
GAGTCAAAGACTTAAAGGGCCCAAT #2 ACATACTGCATCTTGGTTATTTCTG #3
TCTGAAGGTAGCATTCTTTGGAGTT #4 CCCAAACACTTACACCAAACTACTG #5
TGGTAACCAGGCCATTTTTGGTGGG #6 GGGAATCCAAGATTGGTCTCCCATA #7
GATTGGTCTCCCATATGCAGAAATA #8 TAGACTCTAGTATTTATGGGTGGAT #9
ATCCTTTTGCCTTCTGGTATACTTC #10 ACTCCAAGGTGATGTTGTACCTCTT #11
GTACCTCTTTTGCTTGCCAAAGTAC 219773_at NOX4 NM_016931 #1
TATAGGACGTCCTCGGTGGAAACTT #2 GTGTTTTCTGTTGTGGACCCAATTC #3
CCCAATTCACTATCCAAGACTCTTC #4 AACTTTTGCCATGAAGCAGGACTCT #5
GGAATCAATCAGCTGTGTTATGCCA #6 GTGGCAACATGACCGTCACATTACA #7
GATGCACACTGTTGATTTTCATGGT #8 ATGGTGGATTCAAGAACTCCCTAGT #9
AGCTGAACTTGCTCAATCTAAGGCT #10 TAAGGCTGATTGTCGTGTTCCTCTT #11
TGTCGTGTTCCTCTTTAAATTGTTT 236028_at IBSP BE466675 #1
GAAGTTCAACTCAGGAAGGTGCAAT #2 GTACTACCGTTCCAGATTTTCTGTA #3
CAAAGTAATAGGCTTCTTGTCCCTT #4 CCCTTTTTTTTCTGGCATGTTATGG #5
TTATCAAGCAGTACACCAACTCATA #6 ATAGTAGTTTTTAACATGCCTGTAG #7
ATGCCTGTAGTATTGCTAACTGCAA #8 AGTTTCTTAATCGCACTACCTATGC #9
CGCACTACCTATGCAACACTGTGTA #10 ACACTGTGTATTAGGTTTATCATCC #11
GTGACCTGTATGTATATTCTAATCT U85658 TFAP2C U85658 #3
AGCAATTTGTTGCTGCTTGTCACCC #4 CAAGTCCCCGTGGAGGTTCTGTATT #5
GAAACAGTGCGTTGAGTGTACAGAT #6 GGGTCTGTAAATACTGGTGCACTTC #7
GTGCACTTCTTACGACTTTTTTGAG #8 CAATAACTTTGTCTCGTTCCTGTTG #9
GTTCCTGTTGGGCTGAACCCTAAGG #10 TTGGAATTGAACTCTCTGCCTGTAA #11
AATGTTCCCCAAATAATTGTTGTGT 206091_at MATN3 NM_002381 #1
TTTTGCTTATTTTGTTGGAGTATTA #2 AAGTGAACATTACATTGCCATTTTT #3
ATTTTGCTTCAGGATCCAAGTGACA #4 GTCTTTTTAATGTTAGTGATCCACC #5
GATTACAGGCTTGAAAGTCTAACTT #6 TTGATACATATAATTCTTTTGGCTT #7
TGCACTGCTCAATTCTGTTTTTCGT #8 TCTGTTTTTCGTTTGCATTGTCTTT #9
TTACCTTTACATATTATCATGTCTA #10 TCATGTCTATTTTTGATGACTCATC #11
GATGACTCATCAATTTTGTCTATTA 204672_s_at ANKRD6 NM_014942 #1
ACAGAACAGGCTCAGTCAGCATCCT #2 AGCATCCTCACCCAGAGATGGCAAC #3
GGCAACATCTATTAAGACCAATGCA #4 GACCAATGCAATACCTTTTCATCTT #5
ATACCTTTTCATCTTCAGCAAATGT #6 TGTTTTTGATCCTTGGCATTGTCAA #7
GGTCCAGTGTATATTTTTCCTTATT #8 TTTTCCCTTTTAGCTATCTGCTAAA #9
AAATGCCACAACTGTACTTTTCCAA #10 TGACAACTTATAGCCTGTCATGCAG #11
GCAGGTCATGTTTCAAATCAAGGCT RIGHT-SIDE Probes 216044_x_at FAM69A
AK027146 #1 TATACACCCATTTTTAACCTCATTT #2 CAAAGGGCCCATCTTAGTATCACGC
#3 TAGTATCACGCAGCTGACTGAGCCC #4 GACTGAGCCCTTCAAAACTGACATC #5
AAAACTGACATCTTAAGGCCCAATC #6 AGGCCCAATCAAGATCCACATATCC #7
GTATATCCTGTGGGCCAAAGGGCTA #8 TATCTAATGTTTTTTTCCCCATGTA #9
TTAGTATTTGCTCCTCTTTCATATT #10 TTCACACGTATACTCAGATTTGGCA #11
TGGCATGTACCTTTCAACATCTCCA 206387_at CDX2 U51096 #1
GACAAGTGGGATTTGGGGCCTCAAG #2 GGGCCTCAAGAAATATACTCTCCCA #4
GGCTTCATTCCGGACTGGCAGAAGC #8 TGACCAAAGACTGCAGAACCCCCAG #9
GAGGGGGTGGTTATTGGACTCCAGG #11 TAGAGAGCCTGTCACCAGAGCTTCT 225582_at
ITPRIP AA425726 #1 CTCGGCTGTGATCAGGGCAACCAAA #2
TTAGACTGAACATGTGCTTGGGCCT #3 CTCTCCCTAGACGCAGTTGCGGGGC #4
TGCGGGGCACTCCAGGGAATGAACC #5 ATGAACCAGCTCAAGTGTGTCCCTA #6
CCTCCTCATTCCATCAGATGCATTT #7 TGCTTTGAAGAGACCCCAGTAACCA #8
AAGCCAAAACCATGCCTGGATCTCC
#9 ATCTTCTGGCTTCTTGTGTGTACAG #10 GAATCTTTTCTGCACCAAAGCTGCT #11
GGTGTTTCATGCTGCCTTATTTATA 201474_s_at ITGA3 NM_002204 #1
GCCACAGACTGAACTCGCAGGGAGT #2 GCAAACGGCAACGTAGCCTGGGCTC #3
ATGGCGGGATCCTCCACAGAGAGGA #4 AGCCTCCAGAAGGCCCCAGAGAGAC #5
GACCCTGCAAGACCACGGAGGGAGC #6 GGAGGGAGCCGACACTTGAATGTAG #7
CCAGCTGAACCATGCGTCAGGGGCC #8 GTCAGGGGCCTAGAGGTGGAGTTCT #9
GTGGAGTTCTTAGCTATCCTTGGCT #10 GTGTCCTAAGGCCCATTTGAGAAGC #11
AGGCTAGTTCCAAAAACCTCTCCTG 225667_s_at FAM84A AI601101 #1
ATAGCATCTATGTCTCTTTCAAGGG #2 GACAGCAAGTATTATGGCCAAAGCC #3
AAAGCCAGTTTCTTGGCATTTCAAA #4 TGGTTTTCATCCTGGATTCATCCCC #5
GGATTCATCCCCTGATCTTAAATCA #6 TAATAACTAACTTACCTTTGCATGT #7
AACTTACTCCTCTTTCAAGTAACAG #8 TATTGTATCTACACACTCCACATTC #9
CATTCTTTACTGTGTCCTACTACTG #10 TGTGTCCTACTACTGTATCTTGGCT #11
TCTTGGCTCCCTGCTGTATTAAACA 227123_at RAB3B AU156710 #1
GAGGCTTCCCTCAGATCAAGGAGCC #2 GCAGATGATCTATCTCTGTGGCCAC #3
GAGATGTCACCTTATGCAATTTGCA #4 TGCATATCATATTCAATTCCCCCAA #5
CCCAACTGCTCTTTCTAATTTATTC #6 ATTCAACTGGGGACCAGGCTGGTCT #7
TGGTCTCATGCCAACCTAGGAGATG #8 TGCAGTTGCCTCTCGATAGGCCTGA #9
GAGGAACAATAGCTCTCACGTCTCT #10 TCTCCTCATCAGATTCTAACTAAGC #11
ATCTATGGTGTTTCCTTGTTCTGTG 218284_at SMAD3 NM_015400 #1
GGTGTAGTGGCTTTTTGGCTCAGCA #2 GGCTCAGCATCCAGAAACACCAAAC #3
GGCTGGCTAAACAAGTGGCCGCGTG #4 CAGCTCTGAGTCAAATCTGGGCCCT #5
CCCACTCCCTTGCTAGGGGTGAAAG #6 GAGCCATCTATCCAAGAAGCCTTCA #7
CTGTTCTGGACTCTGATGTGTGTGG #8 GCCAGCCTGACCTTTTAATAACTTT #9
GCACCTGTTTAAGCATTGTACCCCT #10 GTTAAAGATTTGTGTCCTCTCATTC #11
TCCTCTTGTAAGTGCCCTTCTAATA 205559_s_at PCSK5 NM_006200 #1
GCAACGGAAGAGTCCTGGGCGGAAG #2 GAGTCCTGGGCGGAAGGAGGCTTCT #3
GAAGGAGGCTTCTGTATGCTTGTGA #4 GAGGCTTCTGTATGCTTGTGAAAAA #5
GAAAAAGAACAATCTGTGCCAACGG #6 AATCTGTGCCAACGGAAGGTTCTTC #7
TGTGCCAACGGAAGGTTCTTCAACA #8 ATTTCAAGGCTGAGCAGCCATCTTA #9
GGCTGAGCAGCCATCTTAGATTTCT #10 GAGCAGCCATCTTAGATTTCTTTGT #11
ATTTCTTTGTTCCTGTAGACTTATA 219909_at MMP28 NM_024302 #1
CCTTTGTTCCTTGAAGAATGCAGCA #2 ATGCAGCATTGTCTTTGTCTGTCCC #3
TTGTTTCTTCGGCTAAAGGTACAGT #4 GTACAGTTCCTTTCAAGAGGTAACA #5
GAGAAATTCGAGACCATTTTGCAAG #6 GGCTCAGTTCTTGAAAAACGGTGTC #7
TGGGGATGAAGGCACAGGCGTCTCC #8 GTGGGGTCAGGACACAGAGTGGGAG #9
GAGACTGATGCAGGCCTACCAGTCC #10 TGGCTTTTTGTCTGGGGCTGGAATA #11
GGCTGGAATAAAGAGGTGCCTTCAG
[0169] It is envisioned that many other probes that have an
oligonucleotide length of at least about 20 to 70 nucleotides and
that have binding affinity for the biomarker genes identified here
(NOX4, CDX2, MMP3, FAM69A) may be identified and used according to
the present invention employing the teachings rendered here
together without an undue amount of trial and error. Standard
molecular biology techniques and teachings, such as those provided
in Carlson, S., et al. (2011), Molecular Biology Techniques,
3.sup.rd Edition, Academic Press, may be used to identify specific
oligonucleotide probes, and then used together with or instead of
those specific genetic probes identified here with equal if not
improved efficacy.
[0170] The foregoing description of the exemplary embodiments of
the invention have been presented for the purposes of illustration
and description. They are not intended to be exhaustive or to limit
the invention to the precise forms disclosed. Many modifications
and variations are possible in light of the above teaching. It is
intended that the scope of the invention be limited not with this
detailed description, but rather by the claims appended hereto.
[0171] The above specification, examples and data provide a
complete description of the manufacture and use of the composition
of the invention. Since many embodiments of the invention can be
made without departing from the spirit and scope of the invention,
the invention resides in the claims hereinafter appended.
Sequence CWU 1
1
197121DNAArtificial SequenceDescription of Artificial Sequence
Synthetic oligonucleotide 1ccaggagauu guuggauaat t
21221DNAArtificial SequenceDescription of Artificial Sequence
Synthetic oligonucleotide 2gaguuuccau agggaacuat t
21323DNAArtificial SequenceDescription of Artificial Sequence
Synthetic primer 3gccatgaagc aggactctaa aga 23423DNAArtificial
SequenceDescription of Artificial Sequence Synthetic primer
4ttggcataac acagctgatt gat 23522DNAArtificial SequenceDescription
of Artificial Sequence Synthetic primer 5atgtcagttg ctgcattcct aa
22622DNAArtificial SequenceDescription of Artificial Sequence
Synthetic primer 6tcactcaata gtgctgtggt tt 22725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
7gaaaatcgat gcagccattt ctgat 25825DNAArtificial SequenceDescription
of Artificial Sequence Synthetic probe 8tttatttctt tactggatct tcaca
25925DNAArtificial SequenceDescription of Artificial Sequence
Synthetic probe 9gatcttcaca gttggagttt gaccc 251025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
10taattcttca cctaagtctc tgtga 251125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
11attgaaatgt tcgttttctc ctgcc 251225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
12gtgactcgag tcacactcaa gggaa 251325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
13tgagcgtgaa tctgtatctt gccgg 251425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
14gtatcttgcc ggtcattttt atgtt 251525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
15caaatgggct gctgcttagc ttgca 251625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
16ttagcttgca ccttgtcaca tagag 251725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
17ggggaagcac tcgtgtgcaa cagac 251825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
18ggttacaggt acacacaagc ttgaa 251925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
19tgtagagcat cttatcagcc ataga 252025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
20ggatgtagca aatctctgtc actgc 252125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
21ctctgtcact gcttgagaac tttga 252225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
22gagcttgtgg cagttttgca gactt 252325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
23gacttacatg acttcagcac tttac 252425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
24agcactttac gacatatttt ttact 252525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
25actgatttct gagggatctg ctcca 252625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
26atctgctcca tgtctattct gttat 252725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
27gtatgccaat ttcagtatgt caata 252825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
28gacattctgg tacttctaga tttgc 252925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
29atcacctcag ccaactgtgg ctctt 253025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
30caactgtggc tcttaattta ttgca 253125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
31gcataatgat attcacatcc cctca 253225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
32acatcccctc agttgcagtg aattg 253325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
33gattgttcct ttttagtgac tcatg 253425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
34gttgagttta acaatcctag ctttt 253525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
35aaatattcta catgtcattc agata 253625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
36attatgtata tcttctagcc tttat 253725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
37atcttctagc ctttattctg tactt 253825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
38acatatttct gtcttgcgtg atttg 253925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
39gcgtgatttg tatatttcac tggtt 254025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
40gagtcaaaga cttaaagggc ccaat 254125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
41acatactgca tcttggttat ttctg 254225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
42tctgaaggta gcattctttg gagtt 254325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
43cccaaacact tacaccaaac tactg 254425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
44tggtaaccag gccatttttg gtggg 254525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
45gggaatccaa gattggtctc ccata 254625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
46gattggtctc ccatatgcag aaata 254725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
47tagactctag tatttatggg tggat 254825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
48atccttttgc cttctggtat acttc 254925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
49actccaaggt gatgttgtac ctctt 255025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
50gtacctcttt tgcttgccaa agtac 255125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
51tataggacgt cctcggtgga aactt 255225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
52gtgttttctg ttgtggaccc aattc 255325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
53cccaattcac tatccaagac tcttc 255425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
54aacttttgcc atgaagcagg actct 255525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
55ggaatcaatc agctgtgtta tgcca 255625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
56gtggcaacat gaccgtcaca ttaca 255725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
57gatgcacact gttgattttc atggt 255825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
58atggtggatt caagaactcc ctagt 255925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
59agctgaactt gctcaatcta aggct 256025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
60taaggctgat tgtcgtgttc ctctt 256125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
61tgtcgtgttc ctctttaaat tgttt 256225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
62gaagttcaac tcaggaaggt gcaat 256325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
63gtactaccgt tccagatttt ctgta 256425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
64caaagtaata ggcttcttgt ccctt 256525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
65cccttttttt tctggcatgt tatgg 256625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
66ttatcaagca gtacaccaac tcata 256725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
67atagtagttt ttaacatgcc tgtag 256825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
68atgcctgtag tattgctaac tgcaa 256925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
69agtttcttaa tcgcactacc tatgc 257025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
70cgcactacct atgcaacact gtgta 257125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
71acactgtgta ttaggtttat catcc 257225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
72gtgacctgta tgtatattct aatct 257325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
73agcaatttgt tgctgcttgt caccc 257425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
74caagtccccg tggaggttct gtatt 257525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
75gaaacagtgc gttgagtgta cagat 257625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
76gggtctgtaa atactggtgc acttc 257725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
77gtgcacttct tacgactttt ttgag 257825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
78caataacttt gtctcgttcc tgttg 257925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
79gttcctgttg ggctgaaccc taagg 258025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
80ttggaattga actctctgcc tgtaa 258125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
81aatgttcccc aaataattgt tgtgt 258225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
82ttttgcttat tttgttggag tatta 258325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
83aagtgaacat tacattgcca ttttt 258425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
84attttgcttc aggatccaag tgaca 258525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
85gtctttttaa tgttagtgat ccacc 258625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
86gattacaggc ttgaaagtct aactt 258725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
87ttgatacata taattctttt ggctt 258825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
88tgcactgctc aattctgttt ttcgt 258925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
89tctgtttttc gtttgcattg tcttt 259025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
90ttacctttac atattatcat gtcta 259125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
91tcatgtctat ttttgatgac tcatc 259225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
92gatgactcat caattttgtc tatta 259325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
93acagaacagg ctcagtcagc atcct 259425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
94agcatcctca cccagagatg gcaac 259525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
95ggcaacatct attaagacca atgca 259625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
96gaccaatgca ataccttttc atctt 259725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
97ataccttttc atcttcagca aatgt 259825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
98tgtttttgat ccttggcatt gtcaa 259925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
99ggtccagtgt atatttttcc ttatt 2510025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
100ttttcccttt tagctatctg ctaaa 2510125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
101aaatgccaca actgtacttt tccaa 2510225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
102tgacaactta tagcctgtca tgcag 2510325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
103gcaggtcatg tttcaaatca aggct 2510425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
104tatacaccca tttttaacct cattt 2510525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
105caaagggccc atcttagtat cacgc 2510625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
106tagtatcacg cagctgactg agccc 2510725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
107gactgagccc ttcaaaactg acatc 2510825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
108aaaactgaca tcttaaggcc caatc 2510925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
109aggcccaatc aagatccaca tatcc 2511025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
110gtatatcctg tgggccaaag ggcta 2511125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
111tatctaatgt ttttttcccc atgta 2511225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
112ttagtatttg ctcctctttc atatt 2511325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
113ttcacacgta tactcagatt tggca 2511425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
114tggcatgtac ctttcaacat ctcca 2511525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
115gacaagtggg atttggggcc tcaag 2511625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
116gggcctcaag aaatatactc tccca 2511725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
117ggcttcattc cggactggca gaagc 2511825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
118tgaccaaaga ctgcagaacc cccag 2511925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
119gagggggtgg ttattggact ccagg 2512025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
120tagagagcct gtcaccagag cttct 2512125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
121ctcggctgtg atcagggcaa ccaaa 2512225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
122ttagactgaa catgtgcttg ggcct 2512325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
123ctctccctag acgcagttgc ggggc 2512425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
124tgcggggcac tccagggaat gaacc 2512525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
125atgaaccagc tcaagtgtgt cccta 2512625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
126cctcctcatt ccatcagatg cattt 2512725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
127tgctttgaag agaccccagt aacca 2512825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
128aagccaaaac catgcctgga tctcc 2512925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
129atcttctggc ttcttgtgtg tacag 2513025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
130gaatcttttc tgcaccaaag ctgct 2513125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
131ggtgtttcat gctgccttat ttata 2513225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
132gccacagact gaactcgcag ggagt 2513325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
133gcaaacggca acgtagcctg ggctc 2513425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
134atggcgggat cctccacaga gagga 2513525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
135agcctccaga aggccccaga gagac 2513625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
136gaccctgcaa gaccacggag ggagc 2513725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
137ggagggagcc gacacttgaa tgtag 2513825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
138ccagctgaac catgcgtcag gggcc 2513925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
139gtcaggggcc tagaggtgga gttct 2514025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
140gtggagttct tagctatcct tggct 2514125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
141gtgtcctaag gcccatttga gaagc 2514225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
142aggctagttc caaaaacctc tcctg 2514325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
143atagcatcta tgtctctttc aaggg 2514425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
144gacagcaagt attatggcca aagcc 2514525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
145aaagccagtt tcttggcatt tcaaa 2514625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
146tggttttcat cctggattca tcccc 2514725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
147ggattcatcc cctgatctta aatca 2514825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
148taataactaa cttacctttg catgt 2514925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
149aacttactcc tctttcaagt aacag 2515025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
150tattgtatct acacactcca cattc 2515125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
151cattctttac tgtgtcctac tactg 2515225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
152tgtgtcctac tactgtatct tggct 2515325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
153tcttggctcc ctgctgtatt aaaca 2515425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
154gaggcttccc tcagatcaag gagcc 2515525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
155gcagatgatc tatctctgtg gccac 2515625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
156gagatgtcac cttatgcaat ttgca 2515725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
157tgcatatcat attcaattcc cccaa 2515825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
158cccaactgct ctttctaatt tattc 2515925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
159attcaactgg ggaccaggct ggtct 2516025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
160tggtctcatg ccaacctagg agatg 2516125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
161tgcagttgcc tctcgatagg cctga 2516225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
162gaggaacaat agctctcacg tctct 2516325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
163tctcctcatc agattctaac taagc 2516425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
164atctatggtg tttccttgtt ctgtg 2516525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
165ggtgtagtgg ctttttggct cagca 2516625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
166ggctcagcat ccagaaacac caaac 2516725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
167ggctggctaa acaagtggcc gcgtg 2516825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
168cagctctgag tcaaatctgg gccct 2516925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
169cccactccct tgctaggggt gaaag 2517025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
170gagccatcta tccaagaagc cttca 2517125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
171ctgttctgga ctctgatgtg tgtgg 2517225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
172gccagcctga ccttttaata acttt 2517325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
173gcacctgttt aagcattgta cccct 2517425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
174gttaaagatt tgtgtcctct cattc 2517525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
175tcctcttgta agtgcccttc taata 2517625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
176gcaacggaag agtcctgggc ggaag 2517725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
177gagtcctggg cggaaggagg cttct 2517825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
178gaaggaggct tctgtatgct tgtga 2517925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
179gaggcttctg tatgcttgtg aaaaa 2518025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
180gaaaaagaac aatctgtgcc aacgg 2518125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
181aatctgtgcc aacggaaggt tcttc 2518225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
182tgtgccaacg gaaggttctt caaca 2518325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
183atttcaaggc tgagcagcca tctta 2518425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
184ggctgagcag ccatcttaga tttct 2518525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
185gagcagccat cttagatttc tttgt 2518625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
186atttctttgt tcctgtagac ttata 2518725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
187cctttgttcc ttgaagaatg cagca 2518825DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
188atgcagcatt gtctttgtct gtccc 2518925DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
189ttgtttcttc ggctaaaggt acagt 2519025DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
190gtacagttcc tttcaagagg taaca 2519125DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
191gagaaattcg agaccatttt gcaag 2519225DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
192ggctcagttc ttgaaaaacg gtgtc 2519325DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
193tggggatgaa ggcacaggcg tctcc 2519425DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
194gtggggtcag gacacagagt gggag 2519525DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
195gagactgatg caggcctacc agtcc 2519625DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
196tggctttttg tctggggctg gaata 2519725DNAArtificial
SequenceDescription of Artificial Sequence Synthetic probe
197ggctggaata aagaggtgcc ttcag 25
* * * * *
References