U.S. patent application number 14/265914 was filed with the patent office on 2014-10-30 for urinary biomarkers for cancer diagnosis.
This patent application is currently assigned to YEDA RESEARCH AND DEVELOPMENT CO. LTD.. The applicant listed for this patent is MOR - RESEARCH APPLICATIONS LTD., YEDA RESEARCH AND DEVELOPMENT CO. LTD.. Invention is credited to Jack BANIEL, Irun R. COHEN, David MARGEL, Meirav PEVSNER-FISCHER, Ofer YOSSEPOWITCH.
Application Number | 20140323355 14/265914 |
Document ID | / |
Family ID | 43425849 |
Filed Date | 2014-10-30 |
United States Patent
Application |
20140323355 |
Kind Code |
A1 |
COHEN; Irun R. ; et
al. |
October 30, 2014 |
URINARY BIOMARKERS FOR CANCER DIAGNOSIS
Abstract
The present invention is directed to the field of cancer
diagnosis, specifically to the diagnosis of bladder cancer (BC) and
prostate cancer (CaP). More specifically, the invention provides
simple, non-invasive urinary tests characterized by high
sensitivity and specificity, wherein urinary levels of heat shock
proteins and anti-inflammatory cytokines are used as
biomarkers.
Inventors: |
COHEN; Irun R.; (Rehovot,
IL) ; PEVSNER-FISCHER; Meirav; (Rehovot, IL) ;
MARGEL; David; (Rehovot, IL) ; BANIEL; Jack;
(Ramat Gan, IL) ; YOSSEPOWITCH; Ofer; (Ramat
Hasharon, IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
YEDA RESEARCH AND DEVELOPMENT CO. LTD.
MOR - RESEARCH APPLICATIONS LTD. |
REHOVOT
TEL AVIV |
|
IL
IL |
|
|
Assignee: |
YEDA RESEARCH AND DEVELOPMENT CO.
LTD.
REHOVOT
IL
MOR - RESEARCH APPLICATIONS LTD.
TEL AVIV
IL
|
Family ID: |
43425849 |
Appl. No.: |
14/265914 |
Filed: |
April 30, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13388613 |
Mar 2, 2012 |
8748118 |
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PCT/IL2010/000626 |
Aug 3, 2010 |
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14265914 |
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61230763 |
Aug 3, 2009 |
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Current U.S.
Class: |
506/18 ;
435/7.92; 436/501 |
Current CPC
Class: |
G01N 33/57488 20130101;
G01N 2333/5428 20130101; G01N 2333/5437 20130101; G01N 33/57407
20130101; G01N 33/57434 20130101; G01N 2333/545 20130101 |
Class at
Publication: |
506/18 ; 436/501;
435/7.92 |
International
Class: |
G01N 33/574 20060101
G01N033/574 |
Claims
1. A diagnostic kit comprising i) means for collecting a urine
sample from a subject and ii) means for determining the level of at
least one biomarker selected from the group consisting of IL-13,
IL-1.beta., HSP60, HSP70 and HSP90 in the sample.
2. The kit of claim 1, wherein the means for determining the level
of at least one biomarker comprise at least one antibody directed
to IL-13, HSP60, HSP70 or HSP90.
3. The kit of claim 1, wherein the means for determining the level
of at least one biomarker comprise at least one antibody directed
to IL-13 or IL-1.beta..
4. The kit of claim 2, wherein said kit is for assessing the
presence of bladder cancer in a subject suspected of having blabber
cancer.
5. The kit of claim 4, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to IL-13.
6. The kit of claim 4, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to HSP60.
7. The kit of claim 4, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to HSP70.
8. The kit of claim 4, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to HSP90.
9. The kit of claim 3, wherein said kit is for assessing the
presence of prostate cancer in a subject suspected of having
prostate cancer.
10. The kit of claim 9, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to IL-13.
11. The kit of claim 9, wherein the means for determining the level
of at least one biomarker comprises at least one antibody directed
to IL-1.beta..
Description
FIELD OF THE INVENTION
[0001] The present invention is directed to the field of cancer
diagnosis, specifically the diagnosis of genitourinary cancer such
as bladder cancer and prostate cancer. More specifically, the
invention provides diagnostic methods comprising determining the
levels of urinary heat shock proteins and cytokines.
BACKGROUND OF THE INVENTION
[0002] Bladder cancer (BC) is one of the most common malignancies
in developed countries, ranking as the sixth most frequent
neoplasm. The disease exists in two main forms: non-invasive BC,
which lacks invasion into surrounding muscle tissue and is the more
common form accounting for 75% of all cases, and muscle invasive
BC, in which the tumor spreads into the urinary bladder muscle and
may metastasize.
[0003] The gold standard for detection of BC is cystoscopy;
however, this procedure is invasive, uncomfortable, costly and may
provoke urinary tract infection. Moreover, cystoscopy may miss
certain lesions, in particular small areas of carcinoma in situ.
Currently, cytology is the only established non-invasive adjunct to
cystoscopy. Although cytology is sensitive (70-80%) and highly
specific (90-95%) for the diagnosis of high-grade BC, sensitivity
is as low as 6-38% for detecting low-grade tumors (Bastacky et al.,
1999).
[0004] In BC patients, urine is constantly in close contact with
tumor cells and the urothelium surrounding them. Therefore it has
been suggested that biomarkers in the urine or in tumor cells
isolated from urine samples could be helpful for detecting and
monitoring BC. Among the studied markers, several assays have been
approved by the US FDA, including Bladder tumor antigen (BTA), BTA
stat, Fibrin degradation products (FDP), Nuclear Matrix protein 22
(NMP-22), Immunocyt and FISH (Urovysion) (van Rhijn et al., 2005).
Most of these assays manifest a higher overall sensitivity for BC
compared to urine cytology, but their specificity is much less (van
Rhijn et al., 2005): urinary tract infection, benign prostatic
hypertrophy and renal calculi can affect these assays. Various
other tests have been developed in the effort to identify
biochemical markers that may have diagnostic and prognostic value,
including tests to identify tumor-associated markers in the urine,
serum, and bladder cancer tissue specimens. For example, urinary
immunoglobulins have been found to increase in persons who have
bladder cancer and appear to have some diagnostic and prognostic
value. Other suggested markers are disclosed, for example, in U.S.
Pat. No. 5,221,612, U.S. Pat. No. 7,332,290, U.S. Pat. No.
6,811,995 U.S. Pat. No. 6,280,956, U.S. Pat. No. 6,261,791, U.S.
20050196795, U.S. 20040126775, U.S. 20090136972 and WO
2004/0033641. To date, there is no consensus regarding the
relevance of these tests and their role in enhancing or replacing
cystoscopy.
[0005] The routine use of prostate-specific antigen (PSA) as a
screening tool since the early 1990's has had a deep impact on
early diagnosis of prostate cancer (CaP) and has resulted in an
increase in CaP detection (McDavid et al., 2004). However, the use
of PSA is currently being debated since it is not clear if PSA
screening has led to a decline in mortality due to CaP (Andriole et
al., 2009; Schrader et al., 2009). In addition, the vast amount of
unnecessary biopsies due to false-positive PSA results places a
large burden on the healthcare system and leads to patient
discomfort (Damber et al., 2008). As a result, there is a need for
more specific and more sensitive biomarkers for CaP.
[0006] Cancer is associated with local inflammation (Lin et al.,
2007). Among the many known factors suggested to mediate or
regulate various aspects of inflammatory reactions are heat shock
proteins and cytokines.
[0007] Heat Shock Proteins (HSPs) are a class of functionally
related proteins whose expression is increased when cells are
exposed to elevated temperature or other stress (Lindquist et al.,
1988). In neoplasms, the expression of HSPs is implicated in the
regulation of apoptosis, as a modulator of p53, in the immune
response against tumors, and in multidrug resistance (Kaufmann et
al., 1990; Levine et al., 1991; Ciocca et al., 1993; Cappello et
al., 2008), and HSP expression was found to be altered in certain
tumors (Fuller et al., 1994). Recently, the expression of HSPs in
tumor biopsy material particularly HSP60 and HSP90 were proposed as
prognostic factors in BC. Using immunohistochemical staining,
Lebert et al, showed that decreased expression of these HSPs in the
tumor is correlated with invasive BC (Lebret et al., 2003). In
addition, it was found that low HSP90 expression predicted failure
of immunotherapy (Lebret et al., 2007).
[0008] Secretion of immunosuppressive cytokines is a non-specific
strategy for tumor immune evasion in many malignancies. Thus far,
studies addressing cytokine expression in bladder cancer focused on
the immune response to Bacillus Calmette-Guerin (BCG) immunotherapy
(Bohle et al., 1990; Fleischmann et al., 1989; Saint et al.,
2001).
[0009] Certain studies report the detection of cytokines such as
Interleukin (IL)-6, IL-8 and IL-10 in the urine of BC patients.
Kochac et al. (2004) and Sheryka et al. (2003) suggest that urinary
IL-8 levels are elevated in patients with invasive BC. These
studies did not differentiate between newly diagnosed BC patients
and patients that have been treated with intravesical or other
anti-cancer therapy, known to affect urinary cytokine levels.
Esuvaranathan et al. (1995), aiming to evaluate the effect of BCG
treatment on urinary cytokine levels, report that urinary IL-6
levels are elevated in some of the BC patients. Cai et al. (2007)
attempted to find an association between urinary levels of
IL-6/IL-10 and recurrent BC. The authors indicated that no
difference was found between the IL-6/IL-10 ratio of control
subjects and of patients with initial BC.
[0010] Loskog et al (2007) demonstrated that bladder cancer tissue
is infiltrated by regulatory T-cells expressing large amounts of
TGF-.beta. and IL-10 mRNA. They further confirmed that circulating
T cells of these patients were unresponsive to polyclonal T cell
activation compared to healthy controls. Helmy et al (2007), using
immunelectromicroscopy, reported the expression of TGF-.beta.
protein in exfoliated malignant epithelial (urothelial) cells in
the urine of patients with BC.
[0011] Cardillo and Ippoliti (2006) reported that IL-6, IL-10 and
HSP90 immunoreactivity was higher in prostatic carcinoma (CaP) and
intra-epithelial prostatic neoplasia than in normal prostatic
tissue adjacent to neoplasia, and therefore, changes in their
expression in human CaP samples could be used as a prognostic
marker of disease progression.
[0012] IL-13 was originally described as a T cell--derived cytokine
that inhibits inflammatory cytokine production (Minty et al., 1993;
McKenzie et al., 1993; Punnonen et al., 1993) secreted from immune
cells (Schmid-Grendelmeier et al., 2002; Brown et al., 1989).
Though this original description remains accurate, the known
functions of IL-13 have expanded over the past few years. In
cancer, IL-13 inhibits CD8.sup.+ CTL-mediated tumor
immunosurveillance (Terabe et al., 2000) and contributes to tumor
escape from apoptosis and growth arrest (Skinnider et al., 2001;
Kapp et al., 1999). Type I diabetic patients treated with HSP60
derived peptide, showed lesser need for exogenous insulin that was
positively correlated with IL-13 production by T-cells, thereby
indicating its importance as an anti-inflammatory mediator (Raz et
al., 2001). A recent case-control study demonstrated a highly
significant difference in mRNA and protein expression of IL-13
between patients with bladder cancer and controls (MalekZadeh et
al., 2010; published after the priority date of the present
invention).
[0013] To date, no cytokine or HSP urinary marker is known to
differentiate between BC-afflicted subjects and subjects presenting
with hematuria due to benign pathology, thus having adequate
reliability to be used in clinical diagnosis. There remains an
unmet need for improved compositions and methods for providing
early diagnosis of genitourinary cancer such as bladder cancer or
prostate cancer and for determining disease staging and
prognosis.
SUMMARY OF THE INVENTION
[0014] The present invention provides compositions, methods and
kits for diagnosing cancer, specifically the diagnosis of
genitourinary cancer such as bladder cancer (BC) and prostate
cancer (CaP). More specifically, the invention provides simple,
non-invasive urinary tests, with high sensitivity and specificity
for BC and CaP, wherein urinary levels of heat shock proteins and
anti-inflammatory cytokines are used as biomarkers.
[0015] The present invention is based in part on unexpected results
obtained when testing the levels of protein antigens in
unsedimented urine samples obtained from bladder cancer patients
and control individuals. A distinct set of antigens comprising
certain heat shock proteins (HSPs) and cytokines was identified,
which accurately correlates with the clinical diagnosis of these
patients compared to controls. Moreover, the identified antigen
markers could differentiate between low-grade, non-muscle invasive
disease (non-MI-BC), and high-grade, muscle invasive tumors
(MI-BC). Surprisingly, in contradistinction with previously tested
urinary biomarkers, the marker antigens of the invention
specifically and accurately discriminate not only between BC
patients and healthy control subjects, but also between BC patients
and patients afflicted with non-malignant conditions accompanied by
hematuria, which present with blood components in the urine. The
inventors have also identified urinary biomarkers for CaP, having
increased sensitivity and specificity compared to the currently
used PSA test for CaP.
[0016] Thus, the present invention provides compositions, methods
and kits for diagnosing genitourinary cancer. The compositions,
methods and kits of the invention are unexpectedly useful also for
diagnosing the cancer stage or grade. According to certain
embodiments, the invention provides methods for diagnosing bladder
cancer in a subject, comprising determining the levels of
anti-inflammatory cytokines and/or HSPs in a urine sample obtained
from the subject. In various embodiments, the methods comprise
determining the levels of at least one biomarker selected from the
group consisting of IL-6, IL-8, IL-10, IL-13, TGF-.beta., HSP60,
HSP70 and HSP90. In other embodiments, the methods comprise
determining the levels of a plurality of these biomarkers, e.g. 2,
3, 4 or more of the above-specified biomarkers. Each possibility is
a separate embodiment of the invention.
[0017] According to one aspect of the present invention, there is
provided a method for assessing (or determining) the presence or
absence of bladder cancer in a subject, comprising determining the
level of at least one biomarker selected from the group consisting
of IL-13, IL-10, HSP60, HSP70 and HSP90 in a urine sample obtained
from the subject, wherein a significant elevation in the level of
the at least one biomarker compared to a control value
corresponding to a healthy individual indicates that said subject
is afflicted with bladder cancer. In one embodiment, the subject is
suspected of having bladder cancer. Each possibility is a separate
embodiment of the invention.
[0018] In another embodiment, the biomarkers are selected from the
group consisting of IL-13, IL-10 and HSP60. In yet another
embodiment, the biomarkers are selected from the group consisting
of IL-13 and HSP60. In another particular embodiment, the biomarker
is IL-13. Each possibility is a separate embodiment of the
invention.
[0019] In another embodiment, the method comprises determining the
levels of a plurality of biomarkers. For example, the method
comprises determining the levels of two, three, four or more of the
biomarkers of the invention, e.g. of the biomarkers selected from
the group consisting IL-13, IL-10, IL-8, HSP60, HSP70 and HSP90.
Optionally and preferably, the levels of at least one heat shock
protein and at least one cytokine are measured. In a particular
embodiment, the biomarkers are IL-13 and HSP60. Each possibility is
a separate embodiment of the invention.
[0020] In another embodiment, the control value corresponding to a
healthy individual corresponds to the value in a urine sample
obtained from an individual not afflicted with bladder cancer, e.g.
a healthy individual not afflicted with or diagnosed with a disease
or an individual afflicted with a non-malignant pathology of the
urinary tract (e.g. patients identified with hematuria from benign
causes such as stone disease or benign prostatic hyperplasia). In
some embodiments, the healthy individual is not afflicted with a
genitourinary infection or inflammatory disease, e.g. urinary tract
infection. In other embodiments, the control value may correspond,
for example, to a panel of control samples from a set of healthy
individuals, or a stored set of data corresponding to control
individuals (e.g. healthy individuals or individuals that are not
afflicted with cancer or infection). Each possibility is a separate
embodiment of the invention.
[0021] In other embodiments, the cancer is selected from the group
consisting of transitional cell carcinoma, squamous cell carcinoma
and adenocarcinoma. In a particular embodiment, the cancer is
transitional cell carcinoma. In another embodiment, the subject is
symptomatic. In another embodiment, the subject is asymptomatic.
Each possibility is a separate embodiment of the invention.
[0022] According to other embodiments, the methods of the invention
are useful for discriminating between superficial and invasive
bladder cancer or for determining the stage or grade of the tumor.
In some embodiments, elevated levels of HSP60, HSP70, HSP90, IL-8,
IL-13, IL-6 and/or TGF-.beta. may be indicative for high grade
and/or invasive tumors. Thus, in another aspect, the invention
provides a method for assessing (or determining) the presence or
absence of muscle invasive bladder cancer in a subject, comprising
determining the level of at least one biomarker selected from the
group consisting of HSP60, HSP70 and HSP90 in a urine sample
obtained from the subject, wherein a significant elevation in the
level of the at least one biomarker compared to a control value
(e.g. a value corresponding to a subject having non-invasive BC)
indicates that said subject is afflicted with muscle invasive
bladder cancer. In another embodiment, the method is useful for
determining the presence or absence of muscle invasion in a subject
diagnosed with (or suspected of having) bladder cancer. Each
possibility is a separate embodiment of the invention.
[0023] In a particular embodiment, the biomarker is HSP60. In
another embodiment, the method comprises determining the levels of
a plurality of the biomarkers of the invention biomarkers (e.g.,
two or three biomarkers) selected from the group consisting of
HSP60, HSP70, HSP90, IL-8, IL-13, IL-6 and TGF-.beta.. In another
embodiment, the method involves determining the levels of HSP60,
HSP70 and HSP90 in the sample. Each possibility is a separate
embodiment of the invention.
[0024] The control value may be, for example, a sample obtained
from an individual having non-invasive bladder cancer (e.g.
low-stage bladder cancer). In other embodiments, the control value
may be, for example, corresponding to a panel of control samples
obtained from individuals having non-muscle invasive cancer, or a
stored set of data corresponding to control individuals (e.g.,
afflicted with non-invasive bladder cancer). In some embodiments,
the control value is obtained from individual (or individuals) not
afflicted with a genitourinary infection or inflammatory
disease.
[0025] In another aspect, the invention provides a method for
diagnosing bladder cancer in a subject suspected of having bladder
cancer, comprising: determining the level of IL-13, HSP60, HSP70
and HSP90 in a urine sample obtained from the subject, wherein:
[0026] i. a significant elevation in the level of IL-13 in the
sample compared to a negative control value corresponding to a
healthy individual indicates that said subject is afflicted with
bladder cancer; and [0027] ii. a significant elevation in the level
of HSP60, HSP70 and HSP90 in the sample compared to a positive
control value corresponding to an individual having non-invasive
bladder cancer indicates that said subject is afflicted with
invasive bladder cancer, and a level of HSP60, HSP70 and HSP90
which is not significantly elevated compared to the positive
control value indicates that the subject has non-invasive bladder
cancer.
[0028] According to one particular embodiment, the method
determines between muscle invasive BC and non-invasive BC.
[0029] In another aspect, the present invention provides a method
for assessing the presence or absence of bladder cancer in a
subject suspected of having bladder cancer, comprising determining
the level of at least one cytokine selected from the group
consisting of: IL-13, IL-10 and IL-8, and at least one heat shock
protein selected from the group consisting of HSP60, HSP70, HSP90,
in a urine sample obtained from the subject, wherein a significant
elevation in the level of the at least one cytokine and at least
one HSP compared to a control value corresponding to a healthy
individual, indicates that said subject is afflicted with bladder
cancer.
[0030] In another aspect, the invention provides a method for
determining the presence or absence of prostate cancer in a
subject, comprising determining the level of at least one biomarker
selected from the group consisting of IL-13 and IL-1.beta. in a
urine sample obtained from the subject, wherein a significant
elevation in the level of the at least one biomarker compared to a
control value corresponding to a healthy individual indicates that
said subject is afflicted with prostate cancer. In one embodiment,
the subject is suspected of having prostate cancer. In another
embodiment, the method comprises determining the level of IL-13. In
another embodiment, the method comprises determining the level of
IL-1.beta.. In another embodiment, the method comprises determining
the level of IL-13 and IL-1.beta.. Each possibility is a separate
embodiment of the invention.
[0031] In another embodiment, the control value corresponding to a
healthy individual corresponds to the value in a urine sample
obtained from an individual not afflicted with prostate cancer,
e.g. a healthy individual not afflicted or diagnosed with a
disease, or an individual afflicted with a non-malignant pathology
of the urinary tract. In some embodiments, the healthy individual
is not afflicted with a genitourinary infection or inflammatory
disease. In other embodiments, the control value may correspond,
for example, to a panel of control samples from a set of healthy
individuals, or a stored set of data corresponding to control
individuals (e.g. healthy individuals or individuals that are not
afflicted with cancer or infection).
[0032] In another embodiment, there is provided a method for
diagnosing a genitourinary cancer in a subject in need thereof
(e.g., suspected of having genitourinary cancer), comprising
determining the level of IL-13 in a urine sample obtained from the
subject, wherein a significant elevation in the level of IL-13
compared to a control value corresponding to a healthy individual
indicates that said subject is afflicted with genitourinary
cancer.
[0033] In one embodiment, the cancer is bladder cancer. In certain
embodiments, the method further comprises determining the levels of
at least one heat shock protein selected from the group consisting
of HSP60, HSP70 and HSP90, wherein a significant elevation in the
level of at least one HSP compared to a control value corresponding
to a healthy individual indicates that said subject is afflicted
with bladder cancer. In other embodiments, the method further
comprises determining the levels of at least one additional
cytokine selected from the group consisting of IL-10 and IL-8,
wherein a significant elevation in the level of at least one
cytokine selected from IL-10 and IL-8 compared to a control value
corresponding to a healthy individual, indicates that said subject
is afflicted with bladder cancer. Each possibility is a separate
embodiment of the invention.
[0034] In another embodiment, the cancer is prostate cancer. In one
embodiment, the method further comprises determining the level of
IL-1.beta., wherein a significant elevation in the level of
IL-1.beta. compared to a control value corresponding to a healthy
individual, indicates that said subject is afflicted with prostate
cancer.
[0035] Thus, according to one embodiment, the present invention
provides a method for diagnosing a genitourinary cancer in a
subject in need thereof, comprising determining the level of IL-13
and at least one biomarker selected from the group consisting of
HSP60, HSP70, HSP90, IL-10, IL-8 and IL-1.beta., wherein: [0036]
(i) a significant elevation in the level of IL-13 and at least one
biomarker selected from the group consisting of HSP60, HSP70,
HSP90, IL-10 and IL-8 compared to a control value corresponding to
a healthy individual, indicates that said subject is afflicted with
bladder cancer; and [0037] (ii) a significant elevation in the
level of IL-13 and IL-1.beta. compared to a control value
corresponding to a healthy individual indicates that said subject
is afflicted with prostate cancer.
[0038] Conveniently, the methods of the invention are performed
using an immunoassay. In one embodiment, the methods of the
invention are performed using an enzyme-linked immunosorbent assay
(ELISA). In another embodiment, the methods of the invention are
performed using a bead flow cytometry assay. In another embodiment,
the methods of the invention are performed using a radioimmunoassay
(RIA). In another embodiment, the methods of the invention are
performed using an antibody microarray chip.
[0039] As the methods of the invention are amenable for automation
and are thus suitable for medium and large scale screening, they
may be used e.g. for screening subjects who may be at risk for
developing bladder cancer or prostate cancer, e.g. cigarette
smokers or subjects exposed to other risk factors.
[0040] In various embodiments, a significant elevation in the level
of a biomarker compared to control is indicative of the presence of
bladder cancer. In other embodiments, a significant elevation in
the level of a biomarker compared to control is indicative of the
presence of invasive bladder cancer. In other embodiments, a
significant elevation in the level of a biomarker compared to
control is indicative of the presence of prostate cancer, as
detailed herein.
[0041] In the methods of the invention, a "significant elevation"
in the level or amount of a urinary biomarker refers, in different
embodiments, to a statistically significant elevation, or in other
embodiments to a significant elevation as recognized by a skilled
artisan. For example, without limitation, the present invention
demonstrates that an increase of either 10 ng/ml of HSP60 or 10
pg/ml of IL-13 is associated with more than ten times the chance of
BC.
[0042] According to certain embodiments, the methods of the
invention provide for measuring the levels of biomarkers in a urine
sample without the need to isolate or enrich exfoliated tumor cells
in the urine sample prior to detection. In one embodiment, the
sample is a non-sedimented urine sample. In another embodiment, the
urine sample is substantially free of residual cells.
[0043] In one embodiment, the urine sample is a voided urine
sample. In certain embodiments, the sample is collected from the
subject without a preceding step of bladder scraping or washing. In
another embodiment, the urine sample is obtained non-invasively. In
other embodiments, the urine sample may conveniently be frozen
after being collected from the subject and thawed before
determining the levels of antigens e.g. by an immunoassay.
[0044] According to further aspects the present invention provides
kits suitable for use in methods of diagnosing genitourinary cancer
in a subject. In one embodiment the kits are suitable for
diagnosing bladder cancer in a subject. In another embodiment the
kits are suitable for diagnosing prostate cancer in a subject.
Thus, in another embodiment, there is provided a diagnostic kit
comprising i) means for collecting a urine sample from a subject
and ii) means for determining the level of at least one biomarker
of the invention in the sample. In a particular embodiment, the at
least one biomarker is selected from the group consisting of IL-13,
HSP60, HSP70 and HSP90. In certain embodiments, the means for
determining the levels of at least one biomarker comprise at least
one antibody directed to the biomarkers of the invention (e.g.,
IL-13, HSP60, HSP70 or HSP90). In another particular embodiment,
the means for determining the levels of at least one biomarker
comprise at least one antibody directed to at least one biomarker
selected from the group consisting of IL-13 and IL-10.
[0045] Other objects, features and advantages of the present
invention will become clear from the following description and
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0046] FIG. 1. Urinary concentrations of HSP60 (a), HSP70 (b) and
HSP90 (c). Urine was assayed by ELISA for the presence of HSP 60
(a), 70 (b) and 90 (c). The results are presented by a scatter
plot--each dot represents one patient. Only one dot is presented
when urinary concentrations overlap, the number of overlapping
patients is indicated. The mean of each group is presented by a
line. *, p<0.05 by one-way ANOVA followed by least significant
difference (LSD) post-hoc test.
[0047] FIG. 2. Urinary concentrations of cytokines IL-6 (a), IL-8
(b), IL-10 (c), IL-13 (d) and TGF-.beta. (e). Urine was assayed by
ELISA for the presence of IL-6 (a), IL-8 (b), IL-10 (c), IL-13 (d)
and TGF-.beta. (e). The results are presented by a scatter
plot--each dot represents one patient. Only one dot is presented
when urinary concentrations overlap, the number of overlapping
patients is indicated. *, p<0.05 by one-way ANOVA followed by
least significant difference (LSD) post-hoc test.
[0048] FIG. 3. ROC curve of HSPs (a) and cytokines (b) in BC
detection
[0049] FIG. 4. ROC curve of HSPs (a) and cytokines (b) for BC stage
prediction
[0050] FIG. 5. Urinary concentrations of IL-13 and IL 1.beta..
Urine was assayed by ELISA for the presence of IL-13(A) and
IL-1.beta.(B). The results are presented by a scatter plot--each
dot represents one patient. One dot is presented when urinary
concentrations overlap and the number of overlapping patients is
indicated. *, p<0.05 by student t-test.
[0051] FIG. 6. ROC curve for IL-13, IL 1.beta. and PSA for CaP
detection.
[0052] FIG. 7. Detection of IL-13 as a urinary biomarker of BC.
Urine was assayed by ELISA for the presence of IL-13 as described.
The results are presented in a bar chart--each bar represent
urinary IL-13 concentrations of one patient.
DETAILED DESCRIPTION OF THE INVENTION
[0053] The present invention provides compositions, methods and
kits for diagnosing genitourinary cancer, particularly BC or CaP.
The compositions, methods and kits of the invention are
unexpectedly useful also for diagnosing the stage or grade of the
tumor, wherein urinary levels of certain heat shock proteins and
cytokines are used as biomarkers. The methods of the invention are
useful for diagnosing low-grade, non-muscle invasive bladder cancer
and high-grade, muscle invasive bladder cancer as well as for
discriminating between these tumor types. Moreover, the methods are
useful for differentiating BC patients not only from healthy
individuals, but also from patients with hematuria from benign
causes.
[0054] As exemplified herein below, a distinct set of identified
biomarkers accurately correlated with the clinical diagnosis of BC
and CaP patients compared to controls. In particular, urinary
concentrations of IL-13, IL-10 and IL-8 as well as HSP60, HSP 70
and HSP90 were significantly elevated in patients with BC.
Moreover, the urine concentrations of HSP60, HSP70 and HSP90, and
IL-13, IL-8, IL-6 and TGF-.beta. cytokines differentiated between
low-grade, non-muscle invasive disease (non-MI-BC), and high-grade,
muscle invasive tumors (MI-BC). Surprisingly, urinary
concentrations of IL-13 and IL-1.beta. were significantly elevated
in patients with prostate cancer.
[0055] Thus, the present invention provides compositions, methods
and kits for diagnosing genitourinary cancer, particularly bladder
cancer and prostate cancer, including for diagnosing bladder cancer
stage or grade. While certain reports may have detected specific
cytokines and/or HSPs in the urine of BC or CaP patients, the
present invention relates to, in certain embodiments, determining
the levels of a plurality of biomarkers (e.g. 2, 3, 4, 5 or 6
biomarkers of the invention), thereby providing a significantly
more accurate and reliable assay in discriminating patients and
control subjects than each biomarker alone.
[0056] In one embodiment the subject is a mammal, preferably a
human. According to certain embodiments, diagnosis of the urinary
levels of the biomarkers of the invention may be affected using an
immunoassay. The immunoassay is typically characterized by the use
of specific binding properties of a particular antibody to isolate,
target and/or quantify the antigen (e.g., a biomarker of the
invention). For example, an antibody may be synthesized or
commercially purchased (as exemplified below) to detect the
specific biomarkers of the invention. In one embodiment the IL-13
biomarker has the amino acid sequence as set forth in SEQ ID NO:1
(Accession No: P35225) or a homolog thereof. In another embodiment
the IL-6 biomarker has the amino acid sequence as set forth in SEQ
ID NO:2 (Accession No: P05231) or homolog thereof. In another
embodiment the IL-8 biomarker has the amino acid sequence as set
forth in SEQ ID NO:3 (Accession No: P10145) or a homolog thereof.
In another embodiment the IL-10 biomarker has the amino acid
sequence as set forth in SEQ ID NO:4 (Accession No: P22301) or a
homolog thereof. In another embodiment the TGF-biomarker has the
amino acid sequence as set forth in SEQ ID NO:5 (Accession No:
P01137) or a homolog thereof. In another embodiment the HSP60
biomarker has the amino acid sequence as set forth in SEQ ID NO:6
(Accession No: P10809) or a homolog thereof. In another embodiment
the HSP70 biomarker has the amino acid sequence as set forth in SEQ
ID NO:7 (Accession No: P08107) or a homolog thereof. In another
embodiment the HSP90 biomarker has the amino acid sequence as set
forth in SEQ ID NO:8 (Accession No: P07900) or a homolog thereof.
In another embodiment the IL1-.beta. biomarker has the amino acid
sequence as set forth in SEQ ID NO:9 (Accession No: P01584) or a
homolog thereof.
[0057] The term "homolog" as used herein refers to a polypeptide
which having at least 70%, at least 75%, at least 80%, at least 85%
or at least 90% identity to the biomarker's amino acid sequence.
According to some embodiments, the methods of the invention are
capable of diagnosing BC and/or Cap by detecting fragments or
derivatives of the biomarkers of the invention (e.g., as listed in
SEQ ID NO: 1 to SEQ ID NO: 9).
[0058] According to one embodiment, the present invention provides
a method for assessing the presence or absence of bladder cancer in
a subject, comprising determining the level of at least one
biomarker selected from the group consisting of IL-13, IL-10, IL-8,
HSP60, HSP70 and HSP90 in a urine sample obtained from the subject,
wherein a significant elevation in the level of the at least one
biomarker compared to a control value corresponding to a healthy
individual indicates that said subject is afflicted with bladder
cancer. According to another embodiment, the method comprises
determining the level of IL-13 in a urine sample obtained from the
subject. According to another embodiment, the method comprises
determining the level of IL-10 in a urine sample obtained from the
subject. According to another embodiment, the method comprises
determining the level of IL-8 in a urine sample obtained from the
subject. According to another embodiment, the method comprises
determining the level of HSP60 in a urine sample obtained from the
subject. According to another embodiment, the method comprises
determining the level of HSP70 in a urine sample obtained from the
subject. According to another embodiment, the method comprises
determining the level of HSP90 in a urine sample obtained from the
subject. Each possibility is a separate embodiment of the
invention.
[0059] According to one embodiment, the method comprises
determining the level of at least two biomarkers selected from the
group consisting of IL-13, IL-10, IL-8 HSP60, HSP70 and HSP90. The
at least two biomarkers may be, for example, two cytokines (e.g.,
IL-13 and IL-10, or IL-13 and IL-8), two heat shock protein (e.g.,
HSP60 and HSP70, or HSP60 or HSP90), or alternatively, one cytokine
and one heat shock protein (e.g., IL-13 and HSP60 or IL-10 and
HSP60). Each possibility is a separate embodiment of the invention.
According to another embodiment, the method comprises determining
the level of at least three biomarkers, at least four,
alternatively, at least five biomarkers selected from the group
consisting of IL-13, IL-10, IL-8, HSP60, HSP70 and HSP90. According
to another embodiment, the method may comprise determining the
levels of two, three, four or more of the biomarkers of the
invention, e.g. of the biomarkers selected from the group
consisting IL-13, IL-10, IL-8, HSP60, HSP70 and HSP90. Each
possibility is a separate embodiment of the invention.
[0060] In another embodiment, the invention provides a method for
diagnosing bladder cancer in a subject suspected of having bladder
cancer, comprising: [0061] i. determining the level of IL-13 in a
urine sample obtained from the subject, wherein a significant
elevation in the level of IL-13 in the sample compared to a
negative control value corresponding to a healthy individual
indicates that said subject is afflicted with bladder cancer; and
[0062] ii. determining the level of HSP60, HSP70 and HSP90 in a
urine sample obtained from said subject, wherein a significant
elevation in the level of HSP60, HSP70 and HSP90 in the sample
compared to a positive control value corresponding to an individual
having non-invasive bladder cancer indicates that said subject is
afflicted with invasive bladder cancer, and a level of HSP60, HSP70
and HSP90 which is not significantly elevated compared to the
positive control value indicates that the subject has non-invasive
bladder cancer.
[0063] According to one particular embodiment, the method
determines between muscle invasive BC and non-invasive BC.
[0064] Genitourinary Cancer
[0065] Genitourinary cancers account for about 42% of cancers in
men (primarily as prostate cancer) and 4% in women. Included within
this group are e.g., cancers of the prostate, bladder, urethra and
testicles. Despite significant progress in molecular and cellular
biology that has helped identify specific molecular pathways that
contribute to the biological potential and behavior of
genitourinary cancers, current treatments for advanced prostate,
urethral and bladder cancers remain limited.
[0066] Bladder Cancer
[0067] Ninety percent of bladder cancer cases are transitional cell
carcinomas (TCC) that arise from the inner lining of the bladder
called the urothelium. The other 10% of tumors are squamous cell
carcinoma, adenocarcinoma, sarcoma, small cell carcinoma and
secondary deposits from cancers elsewhere in the body. The pattern
of growth of TCCs can be papillary, sessile (flat) or
carcinoma-in-situ (CIS). Most TCC are papillary carcinomas, which
tend to be superficial and well-differentiated and to grow outward;
sessile tumors are more insidious, tending to invade early and
metastasize. Squamous cell carcinomas are less common and usually
occur in patients with parasitic bladder infestation or chronic
mucosal irritation. Adenocarcinomas may occur as primary tumors or
may reflect metastasis from intestinal carcinoma. In certain
embodiments, the term "adenocarcinoma" refers to primary
adenocarcinoma. In the bladder, carcinoma in situ is high grade but
noninvasive and usually multifocal; it tends to recur.
[0068] In >40% of patients, tumors recur at the same or another
site in the bladder, particularly if tumors are large or poorly
differentiated or if several tumors are present. Bladder cancer
tends to metastasize to the lymph nodes, lungs, liver, and
bone.
[0069] Most BC patients present with unexplained hematuria (gross
or microscopic). Some patients present with anemia, and hematuria
is detected during evaluation. Irritative voiding symptoms
(dysuria, burning, frequency) and pyuria are also common at
presentation. Pelvic pain occurs with advanced cancer, when a
pelvic mass may be palpable. According to certain embodiments, a
"subject suspected of having bladder cancer" indicates that the
subject presents one or more symptoms or signs characteristic of
BC. According to certain embodiments, the subject may have at least
one symptom selected from hematuria, anemia, dysuria, pyuria and
pelvic pain. According to additional embodiments, a subject
suspected if having BC indicates that the subject is at increased
risk, relative to the general population, of developing bladder
cancer. In certain embodiments, a subject has a personal and/or
family medical history that might indicate the occurrences of a
bladder cancer. In another embodiment, a subject has a
susceptibility determined by genetic screening according to
techniques known in the art. Particular embodiments are subjects
who are at risk for developing bladder cancer, e.g. cigarette
smokers or subjects exposed to other risk factors.
[0070] The 1973 WHO grading system for TCCs (papilloma, G1, G2 or
G3) is most commonly used despite being superseded by the 2004 WHO
grading (papillary neoplasm of low malignant potential (PNLMP), low
grade and high grade papillary carcinoma.
[0071] According to the 1997 TNM system Bladder TCC is staged as
follows: Ta--non-invasive papillary tumor; T1--invasive but not as
far as the muscular bladder layer; T2--invasive into the muscular
layer; T3--invasive beyond the muscle into the fat outside the
bladder; T4--invasive into surrounding structures like the
prostate, uterus or pelvic wall.
[0072] The term "invasive" as used herein refers to cells which
have the ability to infiltrate surrounding tissue. The terms
"non-invasive bladder cancer" or "non-invasive papillary tumor" as
used herein refer to a very early cancer or a cancer that has not
spread beyond the tissue of origin. According to particular
embodiments, the non-invasive bladder cancer is selected from Ta or
T1 stages. According to another embodiment, the non-invasive
bladder cancer is at Ta stage. According to another embodiment, the
non-invasive bladder cancer is at T1 stage.
[0073] The term "invasive cancer" refers to cancer that has spread
beyond the layer of tissue in which it started into the normal
surrounding tissues. Invasive cancers may or may not be metastatic.
The term "muscle invasive bladder cancer" as used herein refers to
a tumor that has spread into and/or beyond the muscular layer of
the bladder. According to particular embodiments, the muscle
invasive bladder cancer is selected from at least one stage
selected from T2, T3 or T4 stages, as detailed hereinabove.
[0074] The following stages are used to classify the location,
size, and spread of the cancer, according to the TNM (tumor, lymph
node, and metastases) staging system: Stage 0: Cancer cells are
found only on the inner lining of the bladder. Stage I: Cancer
cells have proliferated to the layer beyond the inner lining of the
urinary bladder but not to the muscles of the urinary bladder.
Stage II: Cancer cells have proliferated to the muscles in the
bladder wall but not to the fatty tissue that surrounds the urinary
bladder. Stage III: Cancer cells have proliferated to the fatty
tissue surrounding the urinary bladder and to the prostate gland,
vagina, or uterus, but not to the lymph nodes or other organs.
Stage 1V: Cancer cells have proliferated to the lymph nodes, pelvic
or abdominal wall, and/or other organs. Recurrent: Cancer has
recurred in the urinary bladder or in another nearby organ after
having been treated. According to particular embodiments, the
non-invasive bladder cancer is selected from stages 0-stage I.
According to particular embodiments, the muscle invasive bladder
cancer is selected from stages II-IV.
[0075] Prostate Cancer
[0076] Adenocarcinoma of the prostate is the most common form of
prostate cancer. Sarcoma of the prostate is rare, occurring
primarily in children. Undifferentiated prostate cancer, squamous
cell carcinoma, and ductal transitional carcinoma also occur
infrequently. Prostatic intraepithelial neoplasia is considered a
possible premalignant histologic change. Hormonal influences
contribute to the course of adenocarcinoma but almost certainly not
to other types of prostate cancer.
[0077] Prostate cancer usually progresses slowly and rarely causes
symptoms until advanced. In advanced disease, symptoms of bladder
outlet obstruction (e.g., straining, hesitancy, weak or
intermittent urine stream, a sense of incomplete emptying, terminal
dribbling) may appear. Bone pain may result from osteoblastic
metastases to bone (commonly pelvis, ribs, vertebral bodies).
[0078] Grading, based on the resemblance of tumor architecture to
normal glandular structure, helps define the aggressiveness of the
tumor. Grading takes into account histologic heterogeneity in the
tumor. The Gleason score is commonly used, wherein the most
prevalent pattern and the next most prevalent pattern are each
assigned a grade of 1 to 5, and the two grades are added to produce
a total score. Most experts consider a score.ltoreq.6 to be well
differentiated, 7 moderately differentiated, and 8 to 10 poorly
differentiated. The lower the score, the less aggressive and
invasive is the tumor and the better is the prognosis. Prostate
cancer is also staged to define extent of the tumor (e.g.
TRUS).
[0079] According to certain embodiments, a "subject suspected of
having prostate cancer" indicates that the subject presents one or
more symptoms or signs characteristic of prostate cancer.
Non-limiting examples of symptom related to prostate cancer are
urinary dysfunction, frequent urination, nocturia, hematuria,
dysuria and bone pain. According to additional embodiments, a
subject suspected of having prostate cancer indicates that the
subject is at increased risk, relative to the general population,
of developing prostate cancer. In certain embodiments, a subject
has a personal and/or family medical history that might indicate
the occurrences of a prostate cancer. In another embodiment, a
subject has a susceptibility determined by genetic screening
according to techniques known in the art. Particular embodiments
are subjects who are at risk for developing prostate cancer, e.g.
cigarette smokers or subjects exposed to other risk factors.
[0080] Antibodies, Immunoassays and Kits
[0081] The present invention provides in some embodiments
diagnostic methods involving determining the urinary levels of the
HSP and cytokine biomarkers of the invention. The methods of the
invention may optionally and conveniently be affected using an
immunoassay. The term "immunoassay" as used herein refers to a
method of detecting or measuring antigens, in this case biomarkers
of genitourinary cancer (e.g., BC and/or CaP), by using antibodies
as reagents. The immunoassay is typically characterized by the use
of specific binding properties of a particular antibody to isolate,
target, and/or quantify the antigen.
[0082] Antibodies, or immunoglobulins, comprise two heavy chains
linked together by disulfide bonds and two light chains, each light
chain being linked to a respective heavy chain by disulfide bonds
in a "Y" shaped configuration. Each heavy chain has at one end a
variable domain (VH) followed by a number of constant domains (CH).
Each light chain has a variable domain (VL) at one end and a
constant domain (CL) at its other end, the light chain variable
domain being aligned with the variable domain of the heavy chain
and the light chain constant domain being aligned with the first
constant domain of the heavy chain (CH1). The variable domains of
each pair of light and heavy chains form the antigen binding site.
The isotype of the heavy chain (gamma, alpha, delta, epsilon or mu)
determines immunoglobulin class (IgG, IgA, IgD, IgE or IgM,
respectively). The light chain is either of two isotypes (kappa,
.kappa. or lambda, .lamda.) found in all antibody classes.
[0083] It should be understood that when the terms "antibody" or
"antibodies" are used, this is intended to include intact
antibodies, such as polyclonal antibodies or monoclonal antibodies
(mAbs), as well as proteolytic fragments thereof such as the Fab or
F(ab').sub.2 fragments. Further included within the scope of the
invention (for example as immunoassay reagents, as detailed herein)
are chimeric antibodies; recombinant and engineered antibodies, and
fragments thereof.
[0084] Exemplary functional antibody fragments comprising whole or
essentially whole variable regions of both light and heavy chains
are defined as follows: (i) Fv, defined as a genetically engineered
fragment consisting of the variable region of the light chain and
the variable region of the heavy chain expressed as two chains;
(ii) single-chain Fv ("scFv"), a genetically engineered
single-chain molecule including the variable region of the light
chain and the variable region of the heavy chain, linked by a
suitable polypeptide linker; (iii) Fab, a fragment of an antibody
molecule containing a monovalent antigen-binding portion of an
antibody molecule, obtained by treating whole antibody with the
enzyme papain to yield the intact light chain and the Fd fragment
of the heavy chain, which consists of the variable and CH1 domains
thereof; (iv) Fab', a fragment of an antibody molecule containing a
monovalent antigen-binding portion of an antibody molecule,
obtained by treating whole antibody with the enzyme pepsin,
followed by reduction (two Fab' fragments are obtained per antibody
molecule); and (v) F(ab')2, a fragment of an antibody molecule
containing a monovalent antigen-binding portion of an antibody
molecule, obtained by treating whole antibody with the enzyme
pepsin (i.e., a dimer of Fab' fragments held together by two
disulfide bonds).
[0085] Methods of generating monoclonal and polyclonal antibodies
are well known in the art. Antibodies may be generated via any one
of several known methods, which may employ induction of in vivo
production of antibody molecules, screening of immunoglobulin
libraries, or generation of monoclonal antibody molecules by
continuous cell lines in culture. Antibody fragments may be
obtained using methods well known in the art, including, but not
limited to by proteolytic hydrolysis of the antibody or by
expression in E. coli or mammalian cells (e.g., Chinese hamster
ovary (CHO)) cell culture or other protein expression systems) of
DNA encoding the fragment. Single-chain Fvs are prepared by
constructing a structural gene comprising DNA sequences encoding
the heavy chain variable and light chain variable domains connected
by an oligonucleotide encoding a peptide linker. The structural
gene is inserted into an expression vector, which is subsequently
introduced into a host cell such as E. coli. The recombinant host
cells synthesize a single polypeptide chain with a linker peptide
bridging the two variable domains.
[0086] Antibodies for detecting the biomarkers of the invention may
be purified or synthesized using methods well known in the art,
e.g. by immunization with HSPs or cytokines antigens as described
herein. HSPs and cytokines, that were identified as biomarkers
according to the invention, have been described, e.g., in Lindquist
et al., 1988; Kaufmann et al., 1990; Levine et al., 1991; Ciocca et
al., 1993; Cappello et al., 2008; Fuller et al., 1994; Lebert et
al., 2003; Lebret et al., 2007; Kochac et al. 2004, Sheryka et al.
2003, Esuvaranathan et al. 1995, Cai et al. 2007, Loskog et al.
2007, Helmy et al. 2007, Cardillo and Ippoliti, 2006, Minty et al.,
1993; McKenzie et al., 1993; Punnonen et al., 1993;
Schmid-Grendelmeier et al., 2002; Brown et al., 1989; Terabe et
al., 2000; Skinnider et al., 2001; Kapp et al., 1999; Raz et al.,
2001; and MalekZadeh et al., 2010 and may be purified,
recombinantly synthesized or purchased as known in the art.
According to certain particular embodiments, the biomarkers have
the amino acid sequence as set forth in SEQ ID NO:1 to SEQ ID NO:9.
Antibodies against the biomarkers of the invention are also
commercially available, e.g. from StressMarq (CITY, Victoria,
Canada), BioSource (Camarillo, Calif.), BioLegend (San Diego,
Calif.), R&D Systems (Minneapolis, Minn.).
[0087] The term "antigen" as used herein is a molecule or a portion
of a molecule capable of being bound by an antibody. The antigen is
typically capable of inducing an animal to produce antibody capable
of binding to an epitope of that antigen. An antigen may have one
or more epitopes. The specific reaction (or specific binding)
referred to above is meant to indicate that the antigen will react,
in a highly selective manner, with its corresponding antibody and
not with the multitude of other antibodies which may be evoked by
other antigens.
[0088] Thus, the immune reactivity of the antibody to the antigen,
i.e. its ability to specifically bind the antigen, may be used to
determine the amount of the antigen in the sample. In another
embodiment, detection of the capacity of an antibody to
specifically bind an antigen may be performed by quantifying
specific antigen-antibody complex formation.
[0089] In certain embodiments, the detection of the biomarker may
be performed using an immunoassay such as an enzyme-linked
immunosorbent assay (ELISA) testing kit. In such assays, for
example, samples are typically incubated in the presence of an
immobilized first specific binding agent (e.g. an antibody) capable
of specifically binding the biomarker. Binding of the biomarker to
said first specific binding agent may be measured using any one of
a variety of known methods, such as using a labeled second specific
binding agent capable of specifically binding the biomarker (at a
different epitope) or the first specific binding agent.
[0090] Exemplary specific binding agents include e.g. monoclonal
antibodies, polyclonal antibodies, and antibody fragments such as
recombinant antibody fragments, single-chain antibodies (scFv) and
the like.
[0091] In some embodiments, various conventional tags or labels may
be used, such as a radioisotope, an enzyme, a chromophore or a
fluorophore. A typical radioisotope is iodine.sup.-125 or
sulfur.sup.-35. Typical enzymes for this purpose include
horseradish peroxidase, horseradish galactosidase and alkaline
phosphatase.
[0092] Alternately, other immunoassays may be used; such techniques
are well known to the ordinarily skilled artisan and have been
described in many standard immunology manuals and texts.
[0093] In some embodiments, the methods of the invention are
suitable for automated or semi-automated analysis, and may enable
clinical, medium or high-throughput screening of multiple samples.
For example, automated ELISA systems such as Biotest's
Quickstep.RTM. ELISA Processor, Maxmat Automated microwell ELISA
analyzer (Maxmat S.A., France), or DSX.TM. Four-Plate System (Dynex
Technologies) may conveniently be used.
[0094] Other suitable assays include for example flow cytometry
assays (such as singleplex and multiplex bead-based Luminex.RTM.
assays (Invitrogen).
[0095] Alternately, biomarkers may be captured on an antibody
microarray. The antibody microarray comprises anti-biomarker
antibodies, for example, a combination of anti-biomarker
antibodies. In general, the sample (e.g., urine) obtained from the
subject is placed on the active surface of a chip for a sufficient
time to allow binding. Then, unbound molecules are washed from the
surface using a suitable eluant, such as phosphate buffered saline.
In general, the more stringent the eluant, the more tightly the
biomarkers must be bound to be retained after the wash. The
retained biomarkers now can be detected by appropriate means.
[0096] Additional exemplary assays may be based on dipstick
technology, as demonstrated, for example, in U.S. Pat. Nos.
4,632,901, 4,313,734 and 4,786,589 5,656,448 and EP 0125118. for
example, U.S. Pat. No. 4,632,901, discloses a flow-through type
immunoassay device comprising antibody (specific to a target
antigen analyte) bound to a porous membrane or filter to which is
added a liquid sample. As the liquid flows through the membrane,
target analyte binds to the antibody. The addition of sample is
followed by addition of labeled antibody. The visual detection of
labeled antibody provides an indication of the presence of target
antigen analyte in the sample. EP 0125118 discloses a sandwich type
dipstick immunoassay in which immunochemical components such as
antibodies are bound to a solid phase. The assay device is "dipped"
for incubation into a sample suspected of containing unknown
antigen analyte. Enzyme-labeled antibody is then added, either
simultaneously or after an incubation period. The device next is
washed and then inserted into a second solution containing a
substrate for the enzyme. The enzyme-label, if present, interacts
with the substrate, causing the formation of colored products which
either deposit as a precipitate onto the solid phase or produce a
visible color change in the substrate solution.
[0097] For example, the method may be performed by the steps
comprising: [0098] a) collecting a urine sample from the subject;
[0099] b) contacting the sample, under conditions such that a
specific antigen-antibody complex may be formed, with at least one
antibody, said antibody being directed to a marker antigen of the
invention (e.g., IL-13, IL-10, IL-8, HSP60, HSP70 or HSP90); [0100]
c) quantifying the amount of antigen-antibody complex formed,
wherein said amount is indicative of the amount of said marker in
said sample.
[0101] An antibody "directed to" an antigen, as used herein is an
antibody which is capable of specifically binding the antigen. The
term "specifically bind" as used herein means that the binding of
an antibody to an antigen is not competitively inhibited by the
presence of non-related molecules. Antibodies directed to IL-6,
IL-8, IL-10, IL-13, TGF-.beta., HSP60, HSP70 and HSP90 may be
prepared using well known methods, for example as detailed
hereinabove. Alternatively, antibodies, or ELISA kits for
determining the presence of these antigens, may be purchased from a
variety of sources. For example, antibodies for detection of HSP60
and HSP90 are commercially available from Santa Cruz Biotechnology
(Santa Cruz, Calif.), antibodies for detection of HSP70 are
commercially available from StressMarq (CITY, Victoria, Canada),
and ELISA antibody sets for detection of IL-6, IL-10 and IL-8, sets
are commercially available from BioLegend (San Diego, Calif.) and
IL-13 and TGF.beta. ELISA, sets are commercially available from
R&D Systems (Minneapolis, Minn.).
[0102] Optionally, steps b) and c) may be repeated for one or more
additional marker antigens of the invention as detailed herein.
[0103] In various embodiments, a significant elevation in the level
of marker compared to control is indicative of the presence of
bladder cancer (or, in other embodiments, of invasive bladder
cancer), as detailed herein. In the methods of the invention, a
"significant elevation" in the level (or amount) of a urinary
marker refers, in different embodiments, to a statistically
significant elevation, or in other embodiments to a significant
elevation as recognized by a skilled artisan. For example, without
limitation, the present invention demonstrates that an increase of
either 10 ng/ml of HSP60 or 10 pg/ml of IL-13 is associated with
more than ten times the chance of BC. In some embodiments, a
statistically significant difference between the level of the
antigen in the sample obtained from the subject compared to a
normal level of the antigen (e.g., the level in a healthy control
population) is an indication that the subject is afflicted with
bladder cancer. In other embodiments, a statistically significant
difference between the level of the antigen in the sample obtained
from the subject compared to the level of the antigen in a subject
afflicted with non-invasive cancer (e.g., the level in a control
population of non-muscle invasive BC patients) is an indication
that the subject is afflicted with invasive bladder cancer.
[0104] The urine sample is obtained or collected from the subject
as is known in the art. In one embodiment, the urine sample is a
voided urine sample. In certain other embodiments, the sample is
collected from the subject without a preceding step of bladder
scraping or washing. In another embodiment, the method further
comprises the step of freezing the urine sample of step a) and
thawing the sample prior to step b). Conveniently, urine samples
may be kept at -20.degree. C. until the analysis is performed.
[0105] In various embodiments, the method of the present invention
further comprises diluting the urine sample before determining the
level of the biomarker, in particular IL-13, in the sample. In one
embodiment, the sample is diluted 1:2, for instance, using PBS. In
another embodiment, the sample is diluted 1:4, 1:6, 1:8, 1:10, 1:15
or 1:20. Preferably, the samples are diluted 1:8. Each possibility
represents a separate embodiment of the present invention.
[0106] In another embodiment, the urine sample undergoes
filtration. In a preferable embodiment, the sample undergoes
ultra-filtration using, for instance, a MILLIPORE Amicon Ultra. As
is known in the art, ultra-filtration relates to a variety of
membrane filtration in which hydrostatic pressure forces a liquid
against a semipermeable membrane. The cut-off of the membrane may
be selected from 3 KD, 10 KD, 30 KD or more. Preferably, the
cut-off used in said filtration is 3 KD. In another embodiment, the
sample is reconstituted (e.g. with PBS). In another embodiment,
following reconstitution, the urine sample is diluted in the range
of times 2-times 10. In another embodiment, the urine sample is
diluted in the range of times 2-times 8. In another embodiment, the
urine sample is diluted in the range of times 2-times 6. In another
embodiment, the urine sample is diluted in the range of times
2-times 4. In another embodiment, the urine sample is diluted times
3. Each possibility represents a separate embodiment of the present
invention.
[0107] In some embodiments, the subject has not received an
anti-cancer treatment (e.g. local or systemic chemotherapy) prior
to (or adjacent to) collecting the urine sample. In one embodiment,
the subject has not received an intravesical therapy (e.g. BCG or
mitomycin treatment). In another embodiment, the subject has not
received an immunomodulating therapy (e.g. anti-inflammatory
drugs). In yet other embodiments, the subject has received an
anti-cancer treatment prior to (or adjacent to) collecting the
urine sample.
[0108] The methods of the invention may, in various embodiments, be
used as a single diagnostic assay, or in combination with other
diagnostic methods such as cytology or cytoscopy, as known in the
art.
[0109] Diagnostic Kits
[0110] According to further aspects the present invention provides
kits suitable for use in methods of diagnosing genitourinary cancer
such as bladder cancer or prostate cancer, in a subject. Thus, in
another embodiment, there is provided a diagnostic kit comprising
i) means for collecting a urine sample from a subject and ii) means
for determining the level of at least one marker of the invention
in the sample.
[0111] In other embodiments, the kit may contain reagents,
detectable labels and/or containers which may be used for measuring
specific binding of antibodies to the marker antigens of the
invention. In other embodiments, the kit may further comprise
negative and/or positive control samples. For example, control
samples may contain a sample from at least one healthy individual
(negative control) or at least one individual identified with
bladder cancer (positive control), a panel of control samples from
a set of healthy individuals or diseased individuals, or a stored
set of data corresponding to control individuals. In another
embodiment, the kit may contain control samples obtained from
patients having superficial or invasive bladder tumors. Optionally,
the kits may further comprise means for preparing or storing the
sample before measuring the antigen levels.
[0112] According to another embodiment, the invention provides a
kit comprising i) means for determining the level of at least one
marker of the invention in a urine sample and ii) at least one
control value or control sample, as described herein. In various
embodiments, the control value or control sample may be a negative
control corresponding to a healthy subject, e.g. a value obtained
from a healthy control individual not diagnosed with a disease, a
panel of control values from a set of healthy individuals, and a
stored set of data corresponding to control individuals that are
not afflicted with bladder cancer, a positive control corresponding
to a subject having low-grade bladder cancer, e.g. a value obtained
from an individual having non-invasive bladder cancer, a panel of
control values obtained from individuals having non-invasive
bladder cancer, and a stored set of data corresponding to control
individuals, or a positive control corresponding to a subject
having invasive bladder cancer, e.g. a value obtained from an
individual having invasive bladder cancer, a panel of control
values obtained from individuals having invasive bladder cancer,
and a stored set of data corresponding to control individuals
having muscle-invasive cancer.
[0113] According to another embodiment, the invention provides a
kit comprising i) means for determining the level of at least one
marker of the invention in a urine sample and ii) instructions for
performing the necessary steps, for diagnosing genitourinary cancer
(e.g., BC or CaP).
[0114] Diagnostic Use
[0115] According to another aspect, the present invention provides
use of means for detecting at least one urinary biomarker selected
from the group consisting of IL-13, IL-10, HSP60, HSP70 and HSP90
for the preparation of a diagnostic composition for assessing (or
determining) the presence or absence of bladder cancer in a
subject. In one embodiment, a significant elevation in the level of
the at least one urinary biomarker compared to a control value
corresponding to a healthy individual indicates that said subject
is afflicted with bladder cancer. In one embodiment, the subject is
suspected of having bladder cancer. In one embodiment, the
biomarkers are selected from the group consisting of IL-13, IL-10
and HSP60. In yet another embodiment, the biomarkers are selected
from the group consisting of IL-13 and HSP60. In another particular
embodiment, the biomarker is IL-13. Each possibility is a separate
embodiment of the invention.
[0116] In another embodiment, the present invention provides use of
means for detecting a plurality of urinary biomarkers selected from
the group consisting of IL-13, IL-10, HSP60, HSP70 and HSP90 for
the preparation of a diagnostic composition for assessing (or
determining) the presence or absence of bladder cancer in a
subject. For example, a significant elevation in the level of the
at least one two, three, four or more of the biomarkers in a urine
sample obtained from the subject, compared to a control value
corresponding to a healthy individual, indicates that said subject
is afflicted with bladder cancer. Optionally and preferably, the
levels of at least one heat shock protein and at least one cytokine
are measured. In a particular embodiment, the biomarkers are IL-13
and HSP60.
[0117] In another aspect, the invention provides use means for
detecting of at least one urinary biomarker selected from the group
consisting of HSP60, HSP70 and HSP90, for the preparation of a
diagnostic composition for assessing (or determining) the presence
or absence of muscle invasive bladder cancer in a subject, wherein
a significant elevation in the level of the at least one biomarker
compared to a control value indicates that said subject is
afflicted with muscle invasive bladder cancer.
[0118] According to another aspect, the present invention provides
use of means for detecting at least one urinary biomarker selected
from the group consisting of IL-13 and IL-1.beta. for the
preparation of a diagnostic composition for assessing (or
determining) the presence or absence of prostate cancer in a
subject, wherein a significant elevation in the level of the at
least one biomarker compared to a control value corresponding to a
healthy individual indicates that said subject is afflicted with
prostate cancer. In one embodiment, the subject is suspected of
having prostate cancer.
[0119] In another embodiment, the present invention provides use of
means for detecting IL-13 for the preparation of a diagnostic
composition for diagnosing a genitourinary cancer in a subject in
need thereof (e.g., suspected of having genitourinary cancer),
wherein a significant elevation in the level of IL-13, in a urine
sample obtained from the subject, compared to a control value
corresponding to a healthy individual indicates that said subject
is afflicted with genitourinary cancer. According to one
embodiment, the present invention provides means for detecting
IL-13 and at least one biomarker selected from the group consisting
of HSP60, HSP70, HSP90, IL-10, IL-8 and IL-1.beta. for diagnosing a
genitourinary cancer in said subject, wherein: [0120] (i) a
significant elevation in the level of IL-13 and at least one
biomarker selected from the group consisting of HSP60, HSP70,
HSP90, IL-10 and IL-8 compared to a control value corresponding to
a healthy individual, indicates that said subject is afflicted with
bladder cancer; and [0121] (ii) a significant elevation in the
level of IL-13 and IL-1.beta. compared to a control value
corresponding to a healthy individual indicates that said subject
is afflicted with prostate cancer.
[0122] In another embodiment, the method comprises determining the
level of IL-13, HSP60, HSP70 and HSP90 in a urine sample obtained
from the subject, wherein: [0123] i. a significant elevation in the
level of IL-13 in the sample compared to a negative control value
corresponding to a healthy individual indicates that said subject
is afflicted with bladder cancer; and in a subject thus diagnosed
as having bladder cancer [0124] ii. a significant elevation in the
level of HSP60, HSP70 and HSP90 in the sample compared to a
positive control value corresponding to an individual having
non-invasive bladder cancer indicates that said subject is
afflicted with invasive bladder cancer, and a level of HSP60, HSP70
and HSP90 which is not significantly elevated compared to the
positive control value indicates that the subject has non-invasive
bladder cancer.
[0125] The following examples are presented in order to more fully
illustrate some embodiments of the invention. They should, in no
way be construed, however, as limiting the broad scope of the
invention.
EXAMPLES
A. Human Subjects and Methods--BC Diagnosis
Subjects
[0126] The study was approved by the Rabin Medical Center
Institutional Review Board. Banked serum and urine samples were
obtained from 106 consecutive patients--88 of whom were undergoing
cystoscopy and biopsy for suspected bladder cancer--and from 18
age-matched healthy controls. The serum and urine specimens were
taken before cystoscopy, immediately frozen and stored at
-20.degree. C. The healthy controls were assigned to Group 1. The
biopsied subjects were assigned to the following categories after
transurethral resection (TUR) of suspected lesions: Group
2--hematuria with no evidence of malignancy (n=20); Group
3--non-muscle invasive BC, stage=CIS, Ta or T1 (non-MI-BC; n=50);
Group 4-muscle-invasive BC, stage.gtoreq.T2 (MI-BC; n=18). One
patient with a positive urine culture indicating bacterial cystitis
was excluded.
[0127] Table 1 presents the clinical and pathological
characteristics of the subjects. There were no significant
differences between the various groups in age, smoking status,
renal function, or type II diabetes. TUR specimens were processed
and analyzed by a single genitourinary pathologist according to a
standardized protocol. Pathological staging was reported in
accordance with the 1997 Tumor-Node-Metastasis Classification, and
assigned grade according to the WHO classification.
TABLE-US-00001 TABLE 1 Subject characteristics Muscle Non-Muscle
Hematuria Healthy invasive BC invasive BC No BC Control p n = 18 n
= 50 n = 20 n = 18 value Age 71.5 .+-. 10.13 69.3 .+-. 10.21 66
.+-. 15.2 65.9 .+-. 6.7 N.S (mean .+-. SD) Gender (%) M = 80% M =
86% M = 89% M = 90% N.S F = 20% F = 14% F = 11% F = 10% Smoking (%)
53% 44% 55% 55% N.S Creatinine 1.2 .+-. 0.16 1.02 .+-. 0.3 1.3 .+-.
0.22 0.9 .+-. 0.11 N.S Diabetes (%) 53% 32% 50% 40% N.S
Reagents
[0128] Human HSP 60 was prepared as described (Quintana et al.,
2000). HSP 70 and HSP90 were purchased from StressGen
Biotechnologies (Victoria, BC, Canada). Antibodies for detection of
HSP60 and HSP90 were purchased from Santa Cruz Biotechnology (Santa
Cruz, Calif.). Antibody for detection of HSP70 was purchased from
StressMarq (CITY, Victoria, Canada). ELISA antibody sets for
detection of IFN.gamma., TNF.alpha., IL-1.beta. and IL-2 were
purchased from BioSource (Camarillo, Calif.). For IL-6, IL-10 and
IL-8, sets were purchased from BioLegend (San Diego, Calif.). For
IL-4, 13 and TGF.beta., sets were purchased from R&D Systems
(Minneapolis, Minn.).
HSP Measurements
[0129] A direct enzyme-linked immunosorbent assay (ELISA) was used
to quantify HSP concentrations in urine and serum. Assays were done
in triplicate according to the manufacturer's instructions. Minimal
detection concentrations were 20 ng/ml for HSP60 and HSP 70, and 5
ng/ml for HSP 90.
Cytokine Urine Measurements
[0130] Sandwich ELISA was used to quantify cytokine concentrations
in urine. The assays were done in triplicates according to the
manufacturer's instructions. The minimal detection concentration
was 30 pg/ml for each of the cytokines. Patients who had received
treatment with BCG or mitomycin were excluded, because these
intravesical treatments can affect urinary cytokine levels.
Cytokine measurements were performed in 72 subjects. These 72
subjects were stratified according to the pathologic findings as
follows: Group 1--healthy controls (n=18); Group 2--hematuria with
no evidence of malignancy (n=13); Group 3--non-muscle invasive
urothelial carcinoma (non-MI-BC; n=26); Group 4--muscle-invasive
transitional cell carcinoma, stage.gtoreq.T2 (MI-BC; n=15).
[0131] Statistical Analysis
[0132] Univariate analysis was performed to assess the differences
between HSP and cytokine concentrations in the four groups, using
one way ANOVA. When the ANOVA test demonstrated a significant
value, post-hoc LSD (least significant difference) analysis was
used to determine statistically significant differences between the
groups. To assess the association of each measurement with BC, the
test subjects were divided into two groups: subjects with no
bladder cancer (n=32) and patients with BC (n=40).
[0133] The National Cancer Institute recommends evaluating the
performance of potential markers for cancer detection using
receiver operating curves (ROC) (Pepe et al., 2001). Therefore, ROC
were used to calculate the area under the curve and the 95%
confidence interval (AUC.+-.95% CI) for association with the
presence of BC in general and for an association with the stage of
disease: MI-BC and non-MI-BC).
[0134] A multivariate stepwise binary logistic regression to
produce a predictive model utilizing a minimum number of variables
was applied to discriminate between BC and controls. Samples that
included urinary HSP and cytokine measurements were analyzed
(n=72). Subjects were divided into two groups: controls (n=31) and
patients with BC (n=41). The model included urinary HSP and
cytokine concentrations and age. The odds ratio (OR), the 95% CI of
statistically significant markers, and the AUC.+-.95% CI of the
entire model were calculated. The same model was applied for
bladder cancer stage (MI-BC vs. non-MI-BC). Statistical analyses
were carried out using SPSS statistical software version 12.0 (SPSS
Inc, Chicago, Ill.); p<0.05 was considered significant.
IL-13 Detection in an Independent Group
[0135] An independent group of urine samples obtained from BC
patients and controls was studied to evaluate IL-13 as a urinary
biomarker. In these additional urine samples, it was discovered
that the test was encumbered by the presence of inhibitors of IL-13
detection. To overcome this problem, different urine concentrations
were spiked with pure IL-13 and it was discovered that the
inhibitors could be diluted out at 1:8 (Urine:PBS). To inactivate
these inhibitory factors and thus restore the ability to detect the
IL-13, the urine was prepared in the following manner: first, the
urine was filtered using MILLIPORE Amicon Ultra with Cut off of 3
KD (Cat number: UFC500324). The urine volume was then reconstituted
with PBS, and subsequently diluted times 3. The urine was then
assayed for IL-13 by ELISA (Detection limit: 100 pg/ml-3 pg/ml).
The kits were purchased from Orgenium Laboratories, Finland. The
urine levels of IL-13 were analyzed using this approach in groups
composed of 20 controls (no BC) and 20 patients with BC.
Example 1
Urinary Concentrations of Heat Shock Proteins
[0136] FIG. 1A-C depicts the distribution of HSP 60, HSP70 and
HSP90 urinary concentrations classified by the different subject
groups. Urine concentrations of HSP60 (FIG. 1A, Table 2) were
significantly elevated in MI-BC compared to the other groups. The
HSP60 concentration distinguished between healthy controls and BC
patients, but did not separate subjects with hematuria from those
with non-MI-BC. Urinary levels of HSP 70 (FIG. 1B, Table 2) showed
similar concentration patterns between the subject groups. However,
urinary concentrations of HSP70 exhibited a wider distribution than
did HSP60. Urinary HSP90 (FIG. 1C, Table 2) concentrations were
considerably lower than HSP60 and HSP70, but the patterns among the
subject groups were similar. HSP could not be detected in the sera
of BC patients or healthy controls.
TABLE-US-00002 TABLE 2 Urinary HSP and cytokine concentrations
(mean .+-. SD) MI-BC Non-MI-BC Hematuria Healthy HSP 60 ng/ml 52.4
.+-. 7.9 26 .+-. 1.8 24.6 .+-. 0.6 0 .+-. 0 HSP 70 ng/ml 47.5 .+-.
8.2 18.6 .+-. 4.6 8.3 .+-. 2.6 0 .+-. 0 HSP 90 ng/ml 2.6 .+-. 0.71
1.8 .+-. 0.5 0.5 .+-. 0.3 0 .+-. 0 IL-6 pg/ml 90 .+-. 42.5 8 .+-.
4.7 1.2 .+-. 2 0 .+-. 0 IL-8 pg/ml 214.3 .+-. 62.5 151 .+-. 47 9.6
.+-. 7.1 0.9 .+-. 0.5 IL-10 pg/ml 100.5 .+-. 34 152 .+-. 36 2 .+-.
1.1 2.1 .+-. 0.5 IL-13 pg/ml 172 .+-. 22 152 .+-. 15 39 .+-. 25 16
.+-. 15 TGF-.beta. pg/ml 20.4 .+-. 7.8 0 .+-. 0 5.1 .+-. 5.2 0 .+-.
0
Example 2
Urinary Cytokine Concentrations
[0137] The concentrations of the various cytokines in the urine
were examined. IFN.gamma., TNF.alpha., IL-1.beta., IL-2, IL-4 and
IL-5 were not detected; but IL-6, IL-8, IL-10, IL-13 and TGF-.beta.
were detected (FIG. 2 A-E). Urinary concentrations of IL-8, IL-10
and IL-13 (FIG. 2A-C, Table 2) were significantly elevated in BC
patients compared to controls. However they did not distinguish
between MI-BC and non-MI-BC. In contrast to IL-8 and IL-10, all of
the BC patients manifested detectable levels of IL-13.
[0138] Urinary levels of IL-6 and TGF-.beta. (FIGS. 2D and E, Table
2) were significantly elevated in MI-BC compared to the other
groups. Six of 15 patients with MI-BC expressed detectable amounts
of IL-6 or TGF-.beta.. A single control subject with hematuria
manifested elevated IL-6 and a different hematuria subject
manifested elevated TGF-.beta..
Example 3
HSP Molecules and Cytokines are Biomarkers for BC
[0139] Next, a ROC analysis was used to determine the performance
of the various HSP and cytokines as markers for BC according to the
recommendation of the National Cancer Institute for early-phase
biomarker development. FIGS. 3A, and 3B, and table 3 demonstrate
the ROC and the AUC of the HSP and cytokine assays for BC. IL-13
appeared to be the most prominent marker for BC (AUC 0.93; 95% CI
0.85-0.99). However, except for TGF-.beta. and IL-6, the other
positive markers exhibited an AUC of 0.70 or greater for BC.
TABLE-US-00003 TABLE 3 Area under the curve .+-. 95% CI of the ROC
for BC AUC 95% CI p HSP 60 0.84 0.75-0.93 <0.001 HSP 70 0.80
0.70-0.90 <0.001 HSP 90 0.70 0.58-0.82 0.003 IL-6 0.56 0.47-0.73
0.15 IL-8 0.81 0.71-0.91 <0.001 IL-10 0.77 0.66-0.88 <0.001
IL-13 0.93 0.85-0.99 <0.001 TGF-.beta. 0.557 0.42-0.69 0.41
[0140] A multivariate stepwise binary logistic regression analysis
(Table 5) that adjusted for age and included all HSPs and cytokines
was used to identify the minimal number of combined markers
associated with BC. This model highlighted HSP60 and IL-13: HSP 60
(Odds Ratio 1.206; 95% CI 1.041-1.397; p=0.003) and IL-13 (Odds
Ratio 1.020; 95% CI 1.007-1.033; p=0.012). The AUC.+-.95% CI of the
ROC of the multivariate model was 0.95; 95% CI 0.87-0.98.
Example 4
Elevated HSP and Cytokine Measurements are Associated with
MI-BC
[0141] The association of these markers with the stage of BC was
analyzed next. FIG. 4 A B, and Table 4 demonstrate the association
between the stage of BC and urinary HSP and cytokines levels. HSP60
(AUC 0.95; 95% CI 0.91-0.99) showed the closest association with BC
stage in this study. But an AUC of greater than 0.70 was
demonstrated by HSP70, HSP90, IL-8 and IL-13.
TABLE-US-00004 TABLE 4 Area under the curve .+-. 95% CI of the ROC
for MI-BC AUC 95% CI p HSP 60 0.95 0.91-0.99 <0.001 HSP 70 0.93
0.90-0.99 <0.001 HSP 90 0.80 0.66-0.92 <0.001 IL-6 0.67
0.5-0.85 0.04 IL-8 0.76 0.62-0.90 0.002 IL-10 0.58 0.41-0.74 0.32
IL-13 0.77 0.66-0.88 0.001 TGF-.beta. 0.67 0.51-0.86 0.026
[0142] To identify the minimal number of combined markers
associated with MI-BC, a multivariate stepwise binary logistic
regression analysis (Table 5) that adjusted for age and included
HSPs and cytokines was used. This model highlighted HSP60, HSP70
and HSP90: HSP 60 (Odds Ratio 1.093; 95% 1.013-1.179; p=0.022),
HSP70 (Odds Ratio 1.092; 95% CI 1.09-1.128) and HSP90 (Odds Ratio
2.404; 95% CI 1.231-4.694; p=0.01). The AUC.+-.95% CI of the ROC of
the model was 0.96; 95% CI was 0.89-0.98.
TABLE-US-00005 TABLE 5 Stepwise binary logistic regression to
detect BC and MI-BC Marker OR 95% CI p BC IL-13 1.02 1.007-1.033
0.012 HSP 60 1.21 1.041-1.397 0.003 MI-BC HSP 60 1.09 1.013-1.179
0.022 HSP 70 1.09 1.09-1.128 0.004 HSP 90 2.40 1.23-4.694 0.01
Example 5
Detection of IL-13 as a Urinary Biomarker of BC
[0143] Since this is the first report of urinary levels of IL-13 in
BC, experiments were performed to confirm these findings in
independent groups of subjects. FIG. 7 depicts the urinary
concentrations of IL-13 in the confirmation group. As demonstrated,
13 of 20 (65%) BC patients had high urinary IL-13 levels and no
subject in the control group was positive for detectable IL-13
(p<0.001). Therefore IL-13 was identified and confirmed as a
robust urinary biomarker of BC.
B. Human Subjects and Methods--CaP Diagnosis
Subjects
[0144] The study was approved by the Rabin Medical Center
Institutional Review Board. Banked urine samples were obtained from
36 consecutive patients, all were referred for a prostate either
due to an elevated PSA (PSA cutoff was 3 ng/ml; n=27) or abnormal
digital rectal examination (n=5) or both (n=4). Urine samples were
taken before trans-rectal guided biopsy, immediately frozen and
stored at -20.degree. C. Subjects were assigned to two groups
following pathological results of the prostate biopsy: Controls
(n=18)--biopsy negative for CaP; and CaP (n=18)--biopsy positive
for Cap.
[0145] Table 6 presents the clinical and pathological
characteristics of the subjects. There were no significant
differences between the various groups in age, mean PSA value,
percent of positive Digital rectal exam, and percent of patients
with previous negative prostate biopsies.
TABLE-US-00006 TABLE 6 patient and pathology characteristics
Controls (n = 18) CaP (n = 18) p Age ( years) 67 .+-. 5.9 68 .+-.
6.8 N.S. Mean PSA (ng/ml) 8.3 .+-. 6.1 8.9 .+-. 7.9 N.S. Percent of
positive 22% (4 pts) 27% (5 pts) N.S. Digital Rectal Exam Percent
of previous 16 % (3 pts) 27% (5 pts) N.S. negative biopsy Number of
patients Not relevant 61% (11 pts) with low risk CaP Number of
patients Not relevant 39% (7 pts) with intermediate or high risk
CaP
Reagents
[0146] Human HSP60 was prepared as described (6). HSP70 and HSP90
were purchased from StressGen Biotechnologies (Victoria, BC,
Canada). Antibodies for detection of HSP60 and HSP90 were purchased
from Santa Cruz Biotechnology (Santa Cruz, Calif.).
[0147] Antibody for detection of HSP70 was purchased from SterssGen
(Victoria, British Columbia, Canada). Elisa antibody sets for
detection of IFN.gamma., TNF.alpha., IL-1.beta. and IL-2 were
purchased from BioSource (Camarillo, Calif.). For IL-6, IL-10 and
IL-8, sets were purchased from BioLegend (San Diego, Calif.). For
IL-13 and TGF.beta., sets were purchased from R&D Systems
(Minneapolis, Minn.).
HSP Measurements
[0148] A direct enzyme-linked immunosorbent assay (ELISA) was used
to quantify HSP concentrations in urine. Assays were done in
triplicate according to the manufacturer's instructions. Minimal
detection concentrations were 20 ng/ml for HSP60 and HSP70, and 5
ng/ml for HSP90.
Cytokine Urine Measurements
[0149] Sandwich ELISA was used to quantify cytokine concentrations
in urine. The assays were done in triplicates according to the
manufacturer's instructions. The minimal detection concentration
was 30 pg/ml for each of the cytokines.
Statistical Analysis
[0150] Univariate analysis was performed to assess the differences
between HSP and cytokine concentrations in the groups, using
student t test. The National Cancer Institute recommends evaluating
the performance of potential markers for cancer detection using
receiver operating curves (ROC) (7). Therefore, we used ROC to
calculate the area under the curve and the 95% confidence interval
(AUC.+-.95% CI) for association of the detected cytokines and PSA
with biopsy positive CaP.
Example 6
HSP and Cytokine Urine Concentrations in CaP Patients
[0151] The concentrations of the various HSP's and cytokines in the
urine were examined. HSP60, HSP70, HSP90, IFN.gamma., TNF.alpha.,
IL-2, IL-6, IL-8, IL-10 and TGF-.beta. were not detected; but IL-13
and IL-1.beta. were detected. Urinary concentrations of IL-13 and
IL-1.beta. (FIG. 5 A,B) were significantly elevated in CaP patients
compared to controls. Mean.+-.SD values of IL-13 and IL-1.beta. for
CaP patients compared to controls were 50.4.+-.24.8 vs.
16.4.+-.33.5 pg/ml and 19.1.+-.31 vs. 3.2.+-.9.8 pg/ml (p<0.05
for all), respectively.
Example 7
IL-13 and IL-1.beta. as Urinary Biomarkers for CaP
[0152] A ROC analysis was used to determine the performance of
IL-13 and IL-1.beta. as markers for CaP according to the
recommendation of the National Cancer Institute for early-phase
biomarker development. FIG. 6 A demonstrate the ROC curve of IL-13
and IL-1.beta. and PSA for CaP detection. IL-13 appeared to be the
most prominent marker for CaP (AUC 0.88; 95% CI 0.75-0.95). However
IL-1.beta. is promising as well (AUC 0.62; 95% CI 0.45-0.80), both
perform better than PSA.
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[0188] The foregoing description of the specific embodiments will
so fully reveal the general nature of the invention that others
can, by applying current knowledge, readily modify and/or adapt for
various applications such specific embodiments without undue
experimentation and without departing from the generic concept,
and, therefore, such adaptations and modifications should and are
intended to be comprehended within the meaning and range of
equivalents of the disclosed embodiments. It is to be understood
that the phraseology or terminology employed herein is for the
purpose of description and not of limitation. The means, materials,
and steps for carrying out various disclosed functions may take a
variety of alternative forms without departing from the invention.
Sequence CWU 1
1
91146PRTHomo sapiens 1Met His Pro Leu Leu Asn Pro Leu Leu Leu Ala
Leu Gly Leu Met Ala 1 5 10 15 Leu Leu Leu Thr Thr Val Ile Ala Leu
Thr Cys Leu Gly Gly Phe Ala 20 25 30 Ser Pro Gly Pro Val Pro Pro
Ser Thr Ala Leu Arg Glu Leu Ile Glu 35 40 45 Glu Leu Val Asn Ile
Thr Gln Asn Gln Lys Ala Pro Leu Cys Asn Gly 50 55 60 Ser Met Val
Trp Ser Ile Asn Leu Thr Ala Gly Met Tyr Cys Ala Ala 65 70 75 80 Leu
Glu Ser Leu Ile Asn Val Ser Gly Cys Ser Ala Ile Glu Lys Thr 85 90
95 Gln Arg Met Leu Ser Gly Phe Cys Pro His Lys Val Ser Ala Gly Gln
100 105 110 Phe Ser Ser Leu His Val Arg Asp Thr Lys Ile Glu Val Ala
Gln Phe 115 120 125 Val Lys Asp Leu Leu Leu His Leu Lys Lys Leu Phe
Arg Glu Gly Arg 130 135 140 Phe Asn 145 2212PRTHomo sapiens 2Met
Asn Ser Phe Ser Thr Ser Ala Phe Gly Pro Val Ala Phe Ser Leu 1 5 10
15 Gly Leu Leu Leu Val Leu Pro Ala Ala Phe Pro Ala Pro Val Pro Pro
20 25 30 Gly Glu Asp Ser Lys Asp Val Ala Ala Pro His Arg Gln Pro
Leu Thr 35 40 45 Ser Ser Glu Arg Ile Asp Lys Gln Ile Arg Tyr Ile
Leu Asp Gly Ile 50 55 60 Ser Ala Leu Arg Lys Glu Thr Cys Asn Lys
Ser Asn Met Cys Glu Ser 65 70 75 80 Ser Lys Glu Ala Leu Ala Glu Asn
Asn Leu Asn Leu Pro Lys Met Ala 85 90 95 Glu Lys Asp Gly Cys Phe
Gln Ser Gly Phe Asn Glu Glu Thr Cys Leu 100 105 110 Val Lys Ile Ile
Thr Gly Leu Leu Glu Phe Glu Val Tyr Leu Glu Tyr 115 120 125 Leu Gln
Asn Arg Phe Glu Ser Ser Glu Glu Gln Ala Arg Ala Val Gln 130 135 140
Met Ser Thr Lys Val Leu Ile Gln Phe Leu Gln Lys Lys Ala Lys Asn 145
150 155 160 Leu Asp Ala Ile Thr Thr Pro Asp Pro Thr Thr Asn Ala Ser
Leu Leu 165 170 175 Thr Lys Leu Gln Ala Gln Asn Gln Trp Leu Gln Asp
Met Thr Thr His 180 185 190 Leu Ile Leu Arg Ser Phe Lys Glu Phe Leu
Gln Ser Ser Leu Arg Ala 195 200 205 Leu Arg Gln Met 210 399PRTHomo
sapiens 3Met Thr Ser Lys Leu Ala Val Ala Leu Leu Ala Ala Phe Leu
Ile Ser 1 5 10 15 Ala Ala Leu Cys Glu Gly Ala Val Leu Pro Arg Ser
Ala Lys Glu Leu 20 25 30 Arg Cys Gln Cys Ile Lys Thr Tyr Ser Lys
Pro Phe His Pro Lys Phe 35 40 45 Ile Lys Glu Leu Arg Val Ile Glu
Ser Gly Pro His Cys Ala Asn Thr 50 55 60 Glu Ile Ile Val Lys Leu
Ser Asp Gly Arg Glu Leu Cys Leu Asp Pro 65 70 75 80 Lys Glu Asn Trp
Val Gln Arg Val Val Glu Lys Phe Leu Lys Arg Ala 85 90 95 Glu Asn
Ser 4178PRTHomo sapiens 4Met His Ser Ser Ala Leu Leu Cys Cys Leu
Val Leu Leu Thr Gly Val 1 5 10 15 Arg Ala Ser Pro Gly Gln Gly Thr
Gln Ser Glu Asn Ser Cys Thr His 20 25 30 Phe Pro Gly Asn Leu Pro
Asn Met Leu Arg Asp Leu Arg Asp Ala Phe 35 40 45 Ser Arg Val Lys
Thr Phe Phe Gln Met Lys Asp Gln Leu Asp Asn Leu 50 55 60 Leu Leu
Lys Glu Ser Leu Leu Glu Asp Phe Lys Gly Tyr Leu Gly Cys 65 70 75 80
Gln Ala Leu Ser Glu Met Ile Gln Phe Tyr Leu Glu Glu Val Met Pro 85
90 95 Gln Ala Glu Asn Gln Asp Pro Asp Ile Lys Ala His Val Asn Ser
Leu 100 105 110 Gly Glu Asn Leu Lys Thr Leu Arg Leu Arg Leu Arg Arg
Cys His Arg 115 120 125 Phe Leu Pro Cys Glu Asn Lys Ser Lys Ala Val
Glu Gln Val Lys Asn 130 135 140 Ala Phe Asn Lys Leu Gln Glu Lys Gly
Ile Tyr Lys Ala Met Ser Glu 145 150 155 160 Phe Asp Ile Phe Ile Asn
Tyr Ile Glu Ala Tyr Met Thr Met Lys Ile 165 170 175 Arg Asn
5390PRTHomo sapiens 5Met Pro Pro Ser Gly Leu Arg Leu Leu Leu Leu
Leu Leu Pro Leu Leu 1 5 10 15 Trp Leu Leu Val Leu Thr Pro Gly Arg
Pro Ala Ala Gly Leu Ser Thr 20 25 30 Cys Lys Thr Ile Asp Met Glu
Leu Val Lys Arg Lys Arg Ile Glu Ala 35 40 45 Ile Arg Gly Gln Ile
Leu Ser Lys Leu Arg Leu Ala Ser Pro Pro Ser 50 55 60 Gln Gly Glu
Val Pro Pro Gly Pro Leu Pro Glu Ala Val Leu Ala Leu 65 70 75 80 Tyr
Asn Ser Thr Arg Asp Arg Val Ala Gly Glu Ser Ala Glu Pro Glu 85 90
95 Pro Glu Pro Glu Ala Asp Tyr Tyr Ala Lys Glu Val Thr Arg Val Leu
100 105 110 Met Val Glu Thr His Asn Glu Ile Tyr Asp Lys Phe Lys Gln
Ser Thr 115 120 125 His Ser Ile Tyr Met Phe Phe Asn Thr Ser Glu Leu
Arg Glu Ala Val 130 135 140 Pro Glu Pro Val Leu Leu Ser Arg Ala Glu
Leu Arg Leu Leu Arg Leu 145 150 155 160 Lys Leu Lys Val Glu Gln His
Val Glu Leu Tyr Gln Lys Tyr Ser Asn 165 170 175 Asn Ser Trp Arg Tyr
Leu Ser Asn Arg Leu Leu Ala Pro Ser Asp Ser 180 185 190 Pro Glu Trp
Leu Ser Phe Asp Val Thr Gly Val Val Arg Gln Trp Leu 195 200 205 Ser
Arg Gly Gly Glu Ile Glu Gly Phe Arg Leu Ser Ala His Cys Ser 210 215
220 Cys Asp Ser Arg Asp Asn Thr Leu Gln Val Asp Ile Asn Gly Phe Thr
225 230 235 240 Thr Gly Arg Arg Gly Asp Leu Ala Thr Ile His Gly Met
Asn Arg Pro 245 250 255 Phe Leu Leu Leu Met Ala Thr Pro Leu Glu Arg
Ala Gln His Leu Gln 260 265 270 Ser Ser Arg His Arg Arg Ala Leu Asp
Thr Asn Tyr Cys Phe Ser Ser 275 280 285 Thr Glu Lys Asn Cys Cys Val
Arg Gln Leu Tyr Ile Asp Phe Arg Lys 290 295 300 Asp Leu Gly Trp Lys
Trp Ile His Glu Pro Lys Gly Tyr His Ala Asn 305 310 315 320 Phe Cys
Leu Gly Pro Cys Pro Tyr Ile Trp Ser Leu Asp Thr Gln Tyr 325 330 335
Ser Lys Val Leu Ala Leu Tyr Asn Gln His Asn Pro Gly Ala Ser Ala 340
345 350 Ala Pro Cys Cys Val Pro Gln Ala Leu Glu Pro Leu Pro Ile Val
Tyr 355 360 365 Tyr Val Gly Arg Lys Pro Lys Val Glu Gln Leu Ser Asn
Met Ile Val 370 375 380 Arg Ser Cys Lys Cys Ser 385 390 6573PRTHomo
sapiens 6Met Leu Arg Leu Pro Thr Val Phe Arg Gln Met Arg Pro Val
Ser Arg 1 5 10 15 Val Leu Ala Pro His Leu Thr Arg Ala Tyr Ala Lys
Asp Val Lys Phe 20 25 30 Gly Ala Asp Ala Arg Ala Leu Met Leu Gln
Gly Val Asp Leu Leu Ala 35 40 45 Asp Ala Val Ala Val Thr Met Gly
Pro Lys Gly Arg Thr Val Ile Ile 50 55 60 Glu Gln Ser Trp Gly Ser
Pro Lys Val Thr Lys Asp Gly Val Thr Val 65 70 75 80 Ala Lys Ser Ile
Asp Leu Lys Asp Lys Tyr Lys Asn Ile Gly Ala Lys 85 90 95 Leu Val
Gln Asp Val Ala Asn Asn Thr Asn Glu Glu Ala Gly Asp Gly 100 105 110
Thr Thr Thr Ala Thr Val Leu Ala Arg Ser Ile Ala Lys Glu Gly Phe 115
120 125 Glu Lys Ile Ser Lys Gly Ala Asn Pro Val Glu Ile Arg Arg Gly
Val 130 135 140 Met Leu Ala Val Asp Ala Val Ile Ala Glu Leu Lys Lys
Gln Ser Lys 145 150 155 160 Pro Val Thr Thr Pro Glu Glu Ile Ala Gln
Val Ala Thr Ile Ser Ala 165 170 175 Asn Gly Asp Lys Glu Ile Gly Asn
Ile Ile Ser Asp Ala Met Lys Lys 180 185 190 Val Gly Arg Lys Gly Val
Ile Thr Val Lys Asp Gly Lys Thr Leu Asn 195 200 205 Asp Glu Leu Glu
Ile Ile Glu Gly Met Lys Phe Asp Arg Gly Tyr Ile 210 215 220 Ser Pro
Tyr Phe Ile Asn Thr Ser Lys Gly Gln Lys Cys Glu Phe Gln 225 230 235
240 Asp Ala Tyr Val Leu Leu Ser Glu Lys Lys Ile Ser Ser Ile Gln Ser
245 250 255 Ile Val Pro Ala Leu Glu Ile Ala Asn Ala His Arg Lys Pro
Leu Val 260 265 270 Ile Ile Ala Glu Asp Val Asp Gly Glu Ala Leu Ser
Thr Leu Val Leu 275 280 285 Asn Arg Leu Lys Val Gly Leu Gln Val Val
Ala Val Lys Ala Pro Gly 290 295 300 Phe Gly Asp Asn Arg Lys Asn Gln
Leu Lys Asp Met Ala Ile Ala Thr 305 310 315 320 Gly Gly Ala Val Phe
Gly Glu Glu Gly Leu Thr Leu Asn Leu Glu Asp 325 330 335 Val Gln Pro
His Asp Leu Gly Lys Val Gly Glu Val Ile Val Thr Lys 340 345 350 Asp
Asp Ala Met Leu Leu Lys Gly Lys Gly Asp Lys Ala Gln Ile Glu 355 360
365 Lys Arg Ile Gln Glu Ile Ile Glu Gln Leu Asp Val Thr Thr Ser Glu
370 375 380 Tyr Glu Lys Glu Lys Leu Asn Glu Arg Leu Ala Lys Leu Ser
Asp Gly 385 390 395 400 Val Ala Val Leu Lys Val Gly Gly Thr Ser Asp
Val Glu Val Asn Glu 405 410 415 Lys Lys Asp Arg Val Thr Asp Ala Leu
Asn Ala Thr Arg Ala Ala Val 420 425 430 Glu Glu Gly Ile Val Leu Gly
Gly Gly Cys Ala Leu Leu Arg Cys Ile 435 440 445 Pro Ala Leu Asp Ser
Leu Thr Pro Ala Asn Glu Asp Gln Lys Ile Gly 450 455 460 Ile Glu Ile
Ile Lys Arg Thr Leu Lys Ile Pro Ala Met Thr Ile Ala 465 470 475 480
Lys Asn Ala Gly Val Glu Gly Ser Leu Ile Val Glu Lys Ile Met Gln 485
490 495 Ser Ser Ser Glu Val Gly Tyr Asp Ala Met Ala Gly Asp Phe Val
Asn 500 505 510 Met Val Glu Lys Gly Ile Ile Asp Pro Thr Lys Val Val
Arg Thr Ala 515 520 525 Leu Leu Asp Ala Ala Gly Val Ala Ser Leu Leu
Thr Thr Ala Glu Val 530 535 540 Val Val Thr Glu Ile Pro Lys Glu Glu
Lys Asp Pro Gly Met Gly Ala 545 550 555 560 Met Gly Gly Met Gly Gly
Gly Met Gly Gly Gly Met Phe 565 570 7641PRTHomo sapiens 7Met Ala
Lys Ala Ala Ala Ile Gly Ile Asp Leu Gly Thr Thr Tyr Ser 1 5 10 15
Cys Val Gly Val Phe Gln His Gly Lys Val Glu Ile Ile Ala Asn Asp 20
25 30 Gln Gly Asn Arg Thr Thr Pro Ser Tyr Val Ala Phe Thr Asp Thr
Glu 35 40 45 Arg Leu Ile Gly Asp Ala Ala Lys Asn Gln Val Ala Leu
Asn Pro Gln 50 55 60 Asn Thr Val Phe Asp Ala Lys Arg Leu Ile Gly
Arg Lys Phe Gly Asp 65 70 75 80 Pro Val Val Gln Ser Asp Met Lys His
Trp Pro Phe Gln Val Ile Asn 85 90 95 Asp Gly Asp Lys Pro Lys Val
Gln Val Ser Tyr Lys Gly Glu Thr Lys 100 105 110 Ala Phe Tyr Pro Glu
Glu Ile Ser Ser Met Val Leu Thr Lys Met Lys 115 120 125 Glu Ile Ala
Glu Ala Tyr Leu Gly Tyr Pro Val Thr Asn Ala Val Ile 130 135 140 Thr
Val Pro Ala Tyr Phe Asn Asp Ser Gln Arg Gln Ala Thr Lys Asp 145 150
155 160 Ala Gly Val Ile Ala Gly Leu Asn Val Leu Arg Ile Ile Asn Glu
Pro 165 170 175 Thr Ala Ala Ala Ile Ala Tyr Gly Leu Asp Arg Thr Gly
Lys Gly Glu 180 185 190 Arg Asn Val Leu Ile Phe Asp Leu Gly Gly Gly
Thr Phe Asp Val Ser 195 200 205 Ile Leu Thr Ile Asp Asp Gly Ile Phe
Glu Val Lys Ala Thr Ala Gly 210 215 220 Asp Thr His Leu Gly Gly Glu
Asp Phe Asp Asn Arg Leu Val Asn His 225 230 235 240 Phe Val Glu Glu
Phe Lys Arg Lys His Lys Lys Asp Ile Ser Gln Asn 245 250 255 Lys Arg
Ala Val Arg Arg Leu Arg Thr Ala Cys Glu Arg Ala Lys Arg 260 265 270
Thr Leu Ser Ser Ser Thr Gln Ala Ser Leu Glu Ile Asp Ser Leu Phe 275
280 285 Glu Gly Ile Asp Phe Tyr Thr Ser Ile Thr Arg Ala Arg Phe Glu
Glu 290 295 300 Leu Cys Ser Asp Leu Phe Arg Ser Thr Leu Glu Pro Val
Glu Lys Ala 305 310 315 320 Leu Arg Asp Ala Lys Leu Asp Lys Ala Gln
Ile His Asp Leu Val Leu 325 330 335 Val Gly Gly Ser Thr Arg Ile Pro
Lys Val Gln Lys Leu Leu Gln Asp 340 345 350 Phe Phe Asn Gly Arg Asp
Leu Asn Lys Ser Ile Asn Pro Asp Glu Ala 355 360 365 Val Ala Tyr Gly
Ala Ala Val Gln Ala Ala Ile Leu Met Gly Asp Lys 370 375 380 Ser Glu
Asn Val Gln Asp Leu Leu Leu Leu Asp Val Ala Pro Leu Ser 385 390 395
400 Leu Gly Leu Glu Thr Ala Gly Gly Val Met Thr Ala Leu Ile Lys Arg
405 410 415 Asn Ser Thr Ile Pro Thr Lys Gln Thr Gln Ile Phe Thr Thr
Tyr Ser 420 425 430 Asp Asn Gln Pro Gly Val Leu Ile Gln Val Tyr Glu
Gly Glu Arg Ala 435 440 445 Met Thr Lys Asp Asn Asn Leu Leu Gly Arg
Phe Glu Leu Ser Gly Ile 450 455 460 Pro Pro Ala Pro Arg Gly Val Pro
Gln Ile Glu Val Thr Phe Asp Ile 465 470 475 480 Asp Ala Asn Gly Ile
Leu Asn Val Thr Ala Thr Asp Lys Ser Thr Gly 485 490 495 Lys Ala Asn
Lys Ile Thr Ile Thr Asn Asp Lys Gly Arg Leu Ser Lys 500 505 510 Glu
Glu Ile Glu Arg Met Val Gln Glu Ala Glu Lys Tyr Lys Ala Glu 515 520
525 Asp Glu Val Gln Arg Glu Arg Val Ser Ala Lys Asn Ala Leu Glu Ser
530 535 540 Tyr Ala Phe Asn Met Lys Ser Ala Val Glu Asp Glu Gly Leu
Lys Gly 545 550 555 560 Lys Ile Ser Glu Ala Asp Lys Lys Lys Val Leu
Asp Lys Cys Gln Glu 565 570 575 Val Ile Ser Trp Leu Asp Ala Asn Thr
Leu Ala Glu Lys Asp Glu Phe 580 585 590 Glu His Lys Arg Lys Glu Leu
Glu Gln Val Cys Asn Pro Ile Ile Ser 595 600 605 Gly Leu Tyr Gln Gly
Ala Gly Gly Pro Gly Pro Gly Gly Phe Gly Ala 610 615 620 Gln Gly Pro
Lys Gly Gly Ser Gly Ser Gly Pro Thr Ile Glu Glu Val 625 630 635 640
Asp 8732PRTHomo sapiens 8Met Pro Glu Glu Thr Gln Thr Gln Asp Gln
Pro Met Glu Glu Glu Glu 1 5 10 15 Val Glu Thr Phe Ala Phe Gln Ala
Glu Ile Ala Gln Leu Met Ser Leu 20 25 30 Ile Ile Asn Thr Phe Tyr
Ser Asn Lys Glu Ile Phe Leu Arg Glu Leu 35 40 45
Ile Ser Asn Ser Ser Asp Ala Leu Asp Lys Ile Arg Tyr Glu Ser Leu 50
55 60 Thr Asp Pro Ser Lys Leu Asp Ser Gly Lys Glu Leu His Ile Asn
Leu 65 70 75 80 Ile Pro Asn Lys Gln Asp Arg Thr Leu Thr Ile Val Asp
Thr Gly Ile 85 90 95 Gly Met Thr Lys Ala Asp Leu Ile Asn Asn Leu
Gly Thr Ile Ala Lys 100 105 110 Ser Gly Thr Lys Ala Phe Met Glu Ala
Leu Gln Ala Gly Ala Asp Ile 115 120 125 Ser Met Ile Gly Gln Phe Gly
Val Gly Phe Tyr Ser Ala Tyr Leu Val 130 135 140 Ala Glu Lys Val Thr
Val Ile Thr Lys His Asn Asp Asp Glu Gln Tyr 145 150 155 160 Ala Trp
Glu Ser Ser Ala Gly Gly Ser Phe Thr Val Arg Thr Asp Thr 165 170 175
Gly Glu Pro Met Gly Arg Gly Thr Lys Val Ile Leu His Leu Lys Glu 180
185 190 Asp Gln Thr Glu Tyr Leu Glu Glu Arg Arg Ile Lys Glu Ile Val
Lys 195 200 205 Lys His Ser Gln Phe Ile Gly Tyr Pro Ile Thr Leu Phe
Val Glu Lys 210 215 220 Glu Arg Asp Lys Glu Val Ser Asp Asp Glu Ala
Glu Glu Lys Glu Asp 225 230 235 240 Lys Glu Glu Glu Lys Glu Lys Glu
Glu Lys Glu Ser Glu Asp Lys Pro 245 250 255 Glu Ile Glu Asp Val Gly
Ser Asp Glu Glu Glu Glu Lys Lys Asp Gly 260 265 270 Asp Lys Lys Lys
Lys Lys Lys Ile Lys Glu Lys Tyr Ile Asp Gln Glu 275 280 285 Glu Leu
Asn Lys Thr Lys Pro Ile Trp Thr Arg Asn Pro Asp Asp Ile 290 295 300
Thr Asn Glu Glu Tyr Gly Glu Phe Tyr Lys Ser Leu Thr Asn Asp Trp 305
310 315 320 Glu Asp His Leu Ala Val Lys His Phe Ser Val Glu Gly Gln
Leu Glu 325 330 335 Phe Arg Ala Leu Leu Phe Val Pro Arg Arg Ala Pro
Phe Asp Leu Phe 340 345 350 Glu Asn Arg Lys Lys Lys Asn Asn Ile Lys
Leu Tyr Val Arg Arg Val 355 360 365 Phe Ile Met Asp Asn Cys Glu Glu
Leu Ile Pro Glu Tyr Leu Asn Phe 370 375 380 Ile Arg Gly Val Val Asp
Ser Glu Asp Leu Pro Leu Asn Ile Ser Arg 385 390 395 400 Glu Met Leu
Gln Gln Ser Lys Ile Leu Lys Val Ile Arg Lys Asn Leu 405 410 415 Val
Lys Lys Cys Leu Glu Leu Phe Thr Glu Leu Ala Glu Asp Lys Glu 420 425
430 Asn Tyr Lys Lys Phe Tyr Glu Gln Phe Ser Lys Asn Ile Lys Leu Gly
435 440 445 Ile His Glu Asp Ser Gln Asn Arg Lys Lys Leu Ser Glu Leu
Leu Arg 450 455 460 Tyr Tyr Thr Ser Ala Ser Gly Asp Glu Met Val Ser
Leu Lys Asp Tyr 465 470 475 480 Cys Thr Arg Met Lys Glu Asn Gln Lys
His Ile Tyr Tyr Ile Thr Gly 485 490 495 Glu Thr Lys Asp Gln Val Ala
Asn Ser Ala Phe Val Glu Arg Leu Arg 500 505 510 Lys His Gly Leu Glu
Val Ile Tyr Met Ile Glu Pro Ile Asp Glu Tyr 515 520 525 Cys Val Gln
Gln Leu Lys Glu Phe Glu Gly Lys Thr Leu Val Ser Val 530 535 540 Thr
Lys Glu Gly Leu Glu Leu Pro Glu Asp Glu Glu Glu Lys Lys Lys 545 550
555 560 Gln Glu Glu Lys Lys Thr Lys Phe Glu Asn Leu Cys Lys Ile Met
Lys 565 570 575 Asp Ile Leu Glu Lys Lys Val Glu Lys Val Val Val Ser
Asn Arg Leu 580 585 590 Val Thr Ser Pro Cys Cys Ile Val Thr Ser Thr
Tyr Gly Trp Thr Ala 595 600 605 Asn Met Glu Arg Ile Met Lys Ala Gln
Ala Leu Arg Asp Asn Ser Thr 610 615 620 Met Gly Tyr Met Ala Ala Lys
Lys His Leu Glu Ile Asn Pro Asp His 625 630 635 640 Ser Ile Ile Glu
Thr Leu Arg Gln Lys Ala Glu Ala Asp Lys Asn Asp 645 650 655 Lys Ser
Val Lys Asp Leu Val Ile Leu Leu Tyr Glu Thr Ala Leu Leu 660 665 670
Ser Ser Gly Phe Ser Leu Glu Asp Pro Gln Thr His Ala Asn Arg Ile 675
680 685 Tyr Arg Met Ile Lys Leu Gly Leu Gly Ile Asp Glu Asp Asp Pro
Thr 690 695 700 Ala Asp Asp Thr Ser Ala Ala Val Thr Glu Glu Met Pro
Pro Leu Glu 705 710 715 720 Gly Asp Asp Asp Thr Ser Arg Met Glu Glu
Val Asp 725 730 9269PRTHomo sapiens 9Met Ala Glu Val Pro Glu Leu
Ala Ser Glu Met Met Ala Tyr Tyr Ser 1 5 10 15 Gly Asn Glu Asp Asp
Leu Phe Phe Glu Ala Asp Gly Pro Lys Gln Met 20 25 30 Lys Cys Ser
Phe Gln Asp Leu Asp Leu Cys Pro Leu Asp Gly Gly Ile 35 40 45 Gln
Leu Arg Ile Ser Asp His His Tyr Ser Lys Gly Phe Arg Gln Ala 50 55
60 Ala Ser Val Val Val Ala Met Asp Lys Leu Arg Lys Met Leu Val Pro
65 70 75 80 Cys Pro Gln Thr Phe Gln Glu Asn Asp Leu Ser Thr Phe Phe
Pro Phe 85 90 95 Ile Phe Glu Glu Glu Pro Ile Phe Phe Asp Thr Trp
Asp Asn Glu Ala 100 105 110 Tyr Val His Asp Ala Pro Val Arg Ser Leu
Asn Cys Thr Leu Arg Asp 115 120 125 Ser Gln Gln Lys Ser Leu Val Met
Ser Gly Pro Tyr Glu Leu Lys Ala 130 135 140 Leu His Leu Gln Gly Gln
Asp Met Glu Gln Gln Val Val Phe Ser Met 145 150 155 160 Ser Phe Val
Gln Gly Glu Glu Ser Asn Asp Lys Ile Pro Val Ala Leu 165 170 175 Gly
Leu Lys Glu Lys Asn Leu Tyr Leu Ser Cys Val Leu Lys Asp Asp 180 185
190 Lys Pro Thr Leu Gln Leu Glu Ser Val Asp Pro Lys Asn Tyr Pro Lys
195 200 205 Lys Lys Met Glu Lys Arg Phe Val Phe Asn Lys Ile Glu Ile
Asn Asn 210 215 220 Lys Leu Glu Phe Glu Ser Ala Gln Phe Pro Asn Trp
Tyr Ile Ser Thr 225 230 235 240 Ser Gln Ala Glu Asn Met Pro Val Phe
Leu Gly Gly Thr Lys Gly Gly 245 250 255 Gln Asp Ile Thr Asp Phe Thr
Met Gln Phe Val Ser Ser 260 265
* * * * *