U.S. patent application number 14/616565 was filed with the patent office on 2015-08-06 for biomarker signature method, and apparatus and kits therefor.
The applicant listed for this patent is ImmuneXpress Pty Ltd. Invention is credited to Richard Bruce BRANDON, Leo Charles MCHUGH.
Application Number | 20150218640 14/616565 |
Document ID | / |
Family ID | 53754326 |
Filed Date | 2015-08-06 |
United States Patent
Application |
20150218640 |
Kind Code |
A1 |
BRANDON; Richard Bruce ; et
al. |
August 6, 2015 |
BIOMARKER SIGNATURE METHOD, AND APPARATUS AND KITS THEREFOR
Abstract
The present invention discloses methods, kits, and apparatus as
well as reagents and compositions associated therewith for deriving
an indicator for use in diagnosing the presence, absence or degree
of at least one condition in a biological subject or in prognosing
at least one condition in a biological subject. Also disclosed is a
biomarker signature for use in diagnosing the presence, absence or
degree of at least one condition in a biological subject or in
prognosing at least one condition in a biological subject. The
present invention further discloses methods, kits and apparatus, as
well as reagents and compositions associated therewith, for
identifying biomarkers for use in a biomarker signature.
Inventors: |
BRANDON; Richard Bruce;
(Boonah, AU) ; MCHUGH; Leo Charles; (Seattle,
WA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ImmuneXpress Pty Ltd |
Boonah |
|
AU |
|
|
Family ID: |
53754326 |
Appl. No.: |
14/616565 |
Filed: |
February 6, 2015 |
Current U.S.
Class: |
514/169 ; 506/16;
506/17; 506/7; 506/9; 702/19 |
Current CPC
Class: |
A61P 31/04 20180101;
A61P 43/00 20180101; G16B 25/00 20190201; C12Q 2600/118 20130101;
C12Q 1/6883 20130101; G16B 40/00 20190201; C12Q 2600/16
20130101 |
International
Class: |
C12Q 1/68 20060101
C12Q001/68; G06F 19/00 20060101 G06F019/00; G06F 19/22 20060101
G06F019/22 |
Foreign Application Data
Date |
Code |
Application Number |
Feb 6, 2014 |
AU |
2014900363 |
Claims
1. A composition comprising at least one pair of reverse
transcribed mRNAs and at least one oligonucleotide primer or probe
that hybridizes to an individual one of the reverse transcribed
mRNAs, the at least one pair of reverse transcribed mRNAs
comprising a first pair and a second pair of reverse transcribed
mRNAs, wherein the first pair comprises a PLAC8 reverse transcribed
mRNA and a PLA2G7 reverse transcribed mRNA and wherein the second
pair comprises a CEACAM4 reverse transcribed mRNA and a LAMP1
reverse transcribed mRNA.
2. The composition according to claim 1, wherein the at least one
oligonucleotide primer or probe is hybridized to an individual one
of the reverse transcribed mRNAs.
3. The composition according to claim 1, wherein the reverse
transcribed mRNAs are derived from components of the immune
system.
4. The composition according to claim 1, wherein the reverse
transcribed mRNAs are derived from leukocytes.
5. The composition according to claim 1, wherein the reverse
transcribed mRNAs are derived from blood cells.
6. The composition according to claim 1, wherein the reverse
transcribed mRNAs are derived from peripheral blood cells.
7. The composition according to claim 1, further comprising a
labeled reagent for detecting the reverse transcribed mRNAs.
8. The composition according to claim 6, wherein the labeled
reagent is a labeled said at least one oligonucleotide primer or
probe.
9. The composition according to claim 6, wherein the labeled
reagent is a labeled said reverse transcribed mRNA.
10. A method for differentiating between inSIRS and ipSIRS in a
biological subject, the method including: a) obtaining a sample
taken from a biological subject showing a clinical sign of SIRS,
the sample including polynucleotide expression products; b)
quantifying polynucleotide expression products within the sample to
determine a pair of biomarker values, the pair of biomarker values
being selected from the group consisting of: i) a first pair of
biomarker values indicative of a concentration of polynucleotide
expression products of the PLA2G7 gene and PLAC8 gene; ii) a second
pair of biomarker values indicative of a concentration of
polynucleotide expression products of the CEACAM4 gene and LAMP1
gene; c) determining an indicator indicative of a ratio of
concentrations of the polynucleotide expression products using the
pair of biomarker values; d) comparing the indicator to first and
second indicator references, the first and second indicator
references being indicative of inSIRS and ipSIRS, respectively;
and, e) determining a likelihood of the subject having inSIRS or
ipSIRS in accordance with the results of the comparison.
11. The method according to claim 10, wherein the method includes:
a) determining a first derived biomarker value using the first pair
of biomarker values; b) determining a second derived biomarker
value using the second pair of biomarker values; and, c)
determining the indicator by combining the first and second derived
biomarker values.
12. The method according to claim 11, wherein the method includes
combining the derived biomarker values using a combining function,
the combining function being at least one of: a) an additive model;
b) a linear model; c) a support vector machine; d) a neural network
model; e) a random forest model; f) a regression model; g) a
genetic algorithm; h) an annealing algorithm; i) a weighted sum; j)
a nearest neighbour model; and, k) a probabilistic model.
13. The method according to claim 10, wherein the method is
performed at least in part using an electronic processing
device.
14. The method according to claim 11, wherein the method includes,
in at least one electronic processing device: a) obtaining the
pairs of biomarker values; b) determining the first derived
biomarker value; c) determining the second derived biomarker value;
and, d) determining the indicator by adding the first and second
derived biomarker values.
15. The method according to claim 10, wherein the method includes,
in at least one processing device, generating a representation of
the indicator.
16. The method according to claim 15, wherein the representation
includes: a) an alphanumeric indication of the indicator; b) a
graphical indication of a comparison of the indicator to one or
more indicator references; c) an alphanumeric indication of a
likelihood of the subject having at least one medical
condition.
17. The method according to claim 10, wherein the indicator
references are based on at least one of: a) an indicator threshold
range; b) an indicator threshold; and, c) an indicator
distribution.
18. The method according to claim 10, wherein the indicator
references are derived from indicators determined for a number of
individuals in a reference population.
19. The method according to claim 18, wherein the indicator
reference is based on a distribution of indicators determined for a
group of a reference population, the group consisting of
individuals diagnosed as having the medical condition or lacking
the medical condition.
20. The method according to claim 18, wherein the reference
population includes at least one of: a) a plurality of individuals
of different sexes; b) a plurality of individuals of different
ethnicities; c) a plurality of healthy individuals; d) a plurality
of individuals suffering from at least one of inSIRS and ipSIRS; e)
a plurality of individuals lacking at least one of inSIRS and
ipSIRS; f) a plurality of individuals showing clinical signs of at
least one of inSIRS and ipSIRS; g) first and second groups of
individuals, each group of individuals suffering from one of inSIRS
and ipSIRS; and, h) first and second groups of individuals, the
first group of individuals suffering from at least one of inSIRS
and ipSIRS, and the second group lacking one or both of inSIRS and
ipSIRS.
21. The method according to claim 10, wherein the likelihood is
based on a probability generated using the results of the
comparison.
22. The method according to claim 10, wherein the method includes:
a) determining first and second indicator probabilities using the
results of the comparisons; and, b) combining the first and second
indicator probabilities to determine a condition probability
indicative of the likelihood.
23. The method according to claim 10, wherein the method includes:
a) quantifying polynucleotide expression products by: i) amplifying
at least some polynucleotide expression products in the sample;
and, ii) determining an amplification amount representing a degree
of amplification required to obtain a defined level of each of a
pair of polynucleotide expression products; and, b) determining the
indicator by determining a difference between the amplification
amounts.
24. The method according to claim 23, wherein the amplification
amount is at least one of: a) a cycle time; b) a number of cycles;
c) a cycle threshold; d) an amplification time; and, e) relative to
an amplification amount of another amplified product.
25. The method according to claim 23, wherein the method includes
determining: a) a first derived biomarker value by determining a
difference between the amplification amounts of a first pair of
polynucleotide expression products; b) a second derived biomarker
value by determining a difference between the amplification amounts
of a second pair of polynucleotide expression products; c)
determining the indicator by adding the first and second derived
biomarker values.
26. A kit for determining an indicator indicative of the likelihood
of the presence or absence of at least one condition selected from
the group consisting of inSIRS and ipSIRS, the kit comprising at
least one pair of reagents comprising a first pair of reagents and
a second pair of reagents, wherein the first pair of reagents
comprises (i) a reagent that allows quantification of a
polynucleotide expression product of the PLA2G7 gene; and (ii) a
reagent that allows quantification of a polynucleotide expression
product of the PLAC8 gene, wherein the second pair of reagents
comprises: (iii) a reagent that allows quantification of a
polynucleotide expression product of the CEACAM4 gene; and (iv) a
reagent that allows quantification of a polynucleotide expression
product of the LAMP1 gene.
27. A method for inhibiting the development or progression in a
subject of at least one condition selected from the group
consisting of inSIRS and ipSIRS, the method comprising: exposing
the subject to a treatment regimen for treating the at least one
condition based on an indicator obtained from an
indicator-determining method, wherein the indicator is indicative
of the presence of the at least one condition in the subject, the
indicator-determining method comprising: (a) determining at least
one pair of biomarker values, each biomarker value being a value
measured or derived for at least one corresponding immune system
biomarker of the biological subject and being at least partially
indicative of a concentration of the immune system biomarker in a
sample taken from the subject, (b) determining at least one derived
biomarker value using the at least one pair of biomarker values,
the derived biomarker value being indicative of a ratio of
concentrations of the at least one pair of immune system
biomarkers; and (c) determining the indicator based on the at least
one derived biomarker value, wherein the pair of biomarker values
comprises at least one of: a) a first pair of biomarker values
comprising first and second biomarker values corresponding to first
and second biomarkers, wherein the first immune system biomarker
represents a polynucleotide expression product of the PLA2G7 gene
and wherein the second immune system biomarker representing a
polynucleotide expression product of the PLAC8 gene, and b) a
second pair of biomarker values comprises third and fourth
biomarker values corresponding to third and fourth immune system
biomarkers, respectively, wherein the third immune system biomarker
represents a polynucleotide expression product of the CEACAM4 gene
and wherein the fourth immune system biomarker represents a
polynucleotide expression product of the LAMP1 gene.
28. The method according to claim 27, wherein the
indicator-determining method comprises: determining the first pair
and second pair of biomarker values and determining a first derived
biomarker value calculated using the first pair of biomarker values
and a second derived biomarker value calculated using the second
pair of biomarker values; and determining the indicator based on a
combination of the first and second derived biomarker values.
29. The method according to claim 27, comprising: sending the
sample taken from the subject to a laboratory at which the
indicator is determined.
30. The method according to claim 27, wherein the sample comprises
cells obtained from the subject or a nucleic acid sample thereof.
Description
[0001] This application claims priority to Australian Provisional
Application No. 2014900363 entitled "Biomarker signature method,
and apparatus and kits therefor" filed 6 Feb. 2014, the entire
contents of which are incorporated herein by reference.
STATEMENT REGARDING SEQUENCE LISTING
[0002] The Sequence Listing associated with this application is
provided in text format in lieu of a paper copy, and is hereby
incorporated by reference into the specification. The name of the
text file containing the Sequence Listing is
DAVI.sub.--035.sub.--01US_ST25.txt. The text file is 4.4 MB, was
created on Feb. 6, 2015, and is being submitted electronically via
EFS-Web.
BACKGROUND OF THE INVENTION
[0003] The present invention relates to method, kit and apparatus
and to reagents and compositions associated therewith for deriving
an indicator for use in diagnosing the presence, absence or degree
of at least one condition in a biological subject or in prognosing
at least one condition in a biological subject, to a biomarker
signature for use in diagnosing the presence, absence or degree of
at least one condition in a biological subject or in prognosing at
least one condition in a biological subject, and to a method, kit
and apparatus, as well as reagents and compositions associated
therewith, for identifying biomarkers for use in a biomarker
signature.
DESCRIPTION OF THE PRIOR ART
[0004] The reference in this specification to any prior publication
(or information derived from it), or to any matter which is known,
is not, and should not be taken as an acknowledgment or admission
or any form of suggestion that the prior publication (or
information derived from it) or known matter forms part of the
common general knowledge in the field of endeavor to which this
specification relates.
[0005] The analysis of gene expression products for diagnostic
purposes is known. Such analysis requires identification of one or
more genes that can be used to generate a signature for use in
distinguishing between different conditions. However, such
identification can require the analysis of many gene expression
products, which can be mathematically complex, computationally
expensive and hence difficult. Much of the biomarker discovery
process is devoted to identifying a subset of the data that may
have relevant import, from which a signature is derived using a
combination of these values to produce a model for diagnostic or
prognostic use.
[0006] WO2004/044236 describes a method of determining the status
of a subject. In particular, this is achieved by obtaining subject
data including respective values for each of a number of
parameters, the parameter values being indicative of the current
biological status of the subject. The subject data are compared to
predetermined data that includes values for at least some of the
parameters and an indication of the condition. The status of the
subject, and in particular, the presence and/or absence of the one
or more conditions, can then be determined in accordance with the
results of the comparison.
[0007] US2010/0028876 describes methods for diagnosing biological
states or conditions based on ratios of gene expression data from
cell or tissue samples, such as cancer cell or tissue samples, by
differentiating between cell types, including cancer cell types.
The invention provides sets of genes that are expressed
differentially in normal and cancer lung cells and tissues to be
able to differentiate these cells and tissues. Such cellular
differentiation is important in diagnosing cancer and cancer types.
The sets of genes are identified by the degree (fold change) of up
or down regulation. These sets of genes can be used to discriminate
between normal and malignant cells or tissues, and between classes
of malignant cells or tissues. Accordingly, diagnostic assays for
classification of tumors, prediction of tumor outcome, selecting
and monitoring treatment regimens and monitoring tumor
progression/regression also are provided.
[0008] However, traditional methods for biomarker identification
and traditional combinations of biomarkers use a relatively large
number of biomarkers, which in turn makes tests expensive to
perform, limiting their use in practice. In addition, the prior art
does not describe the use of immune system biomarker ratios, or a
method of identifying minimal sets of immune system biomarker
ratios useful in determining the presence, absence, degree or
prognosis of immune system-mediated medical conditions.
SUMMARY OF THE PRESENT INVENTION
[0009] In one broad form the present invention seeks to provide a
method for determining an indicator used in assessing a likelihood
of a biological subject having a presence, absence, degree or
prognosis of at least one medical condition, the method including:
[0010] a) determining a pair of biomarker values, each biomarker
value being a value measured or derived for at least one
corresponding immune system biomarker of the biological subject and
being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject; [0011]
b) determining a derived biomarker value using the pair of
biomarker values, the derived biomarker value being indicative of a
ratio of concentrations of the pair of immune system biomarkers;
and, [0012] c) determining the indicator using the derived
biomarker value.
[0013] Typically the method includes: [0014] a) determining a first
derived biomarker value using a first pair of biomarker values, the
first derived biomarker value being indicative of a ratio of
concentrations of first and second immune system biomarkers; [0015]
b) determining a second derived biomarker value using a second pair
of biomarker values, the second derived biomarker value being
indicative of a ratio of concentrations of third and fourth immune
system biomarkers; and, [0016] c) determining the indicator by
combining the first and second derived biomarker values.
[0017] Typically the method includes combining the derived
biomarker values using a combining function, the combining function
being at least one of: [0018] a) an additive model; [0019] b) a
linear model; [0020] c) a support vector machine; [0021] d) a
neural network model; [0022] e) a random forest model; [0023] f) a
regression model; [0024] g) a genetic algorithm; [0025] h) an
annealing algorithm; [0026] i) a weighted sum; [0027] j) a nearest
neighbor model; and, [0028] k) a probabilistic model.
[0029] Typically the method is performed at least in part using an
electronic processing device.
[0030] Typically the method includes, in at least one electronic
processing device: [0031] a) obtaining at least two pairs of
measured biomarker values, each measured biomarker value being a
measured value of a corresponding immune system biomarker of the
biological subject; [0032] b) determining a first derived biomarker
value indicative of a ratio of concentrations of first and second
immune system biomarkers; [0033] c) determining a second derived
biomarker value indicative of a ratio of third and fourth immune
system biomarkers; and, [0034] d) determining the indicator by
combining the first and second derived biomarker values.
[0035] Typically the method includes, in at least one processing
device, generating a representation of the indicator.
[0036] Typically the representation includes: [0037] a) an
alphanumeric indication of the indicator; [0038] b) a graphical
indication of a comparison of the indicator to one or more
indicator references; [0039] c) an alphanumeric indication of a
likelihood of the subject having at least one medical
condition.
[0040] Typically the method includes: [0041] a) comparing the
indicator to an indicator reference; and, [0042] b) determining a
likelihood in accordance with results of the comparison.
[0043] Typically the indicator reference is based on at least one
of: [0044] a) an indicator threshold range; [0045] b) an indicator
threshold; and, [0046] c) an indicator distribution.
[0047] Typically the indicator reference is derived from indicators
determined for a number of individuals in a reference
population.
[0048] Typically the indicator reference is based on a distribution
of indicators determined for a group of a reference population, the
group consisting of individuals diagnosed as having the medical
condition or lacking the medical condition.
[0049] Typically the reference population includes: [0050] a) a
plurality of individuals of different sexes; [0051] b) a plurality
of individuals of different ethnicities; [0052] c) a plurality of
healthy individuals; [0053] d) a plurality of individuals suffering
from at least one diagnosed medical condition; [0054] e) a
plurality of individuals lacking the at least one diagnosed medical
condition; [0055] f) a plurality of individuals showing clinical
signs of at least one medical condition; [0056] g) first and second
groups of individuals, each group of individuals suffering from a
respective diagnosed medical condition; and, [0057] h) first and
second groups of individuals, the first group of individuals
suffering from a diagnosed medical condition, and the second group
lacking the diagnosed medical condition.
[0058] Typically the indicator is for use in determining the
likelihood that a biological subject has at least one medical
condition, and wherein the reference population includes: [0059] a)
individuals presenting with clinical signs of the at least one
medical condition; [0060] b) individuals diagnosed as having the at
least one medical condition; [0061] c) individuals diagnosed as
lacking the at least one medical condition; and, [0062] d) healthy
individuals.
[0063] Typically the indicator reference is retrieved from a
database.
[0064] Typically the likelihood is based on a probability generated
using the results of the comparison.
[0065] Typically the indicator is for determining a likelihood of
the subject having a first or second condition, and wherein the
method includes: [0066] a) comparing the indicator to first and
second indicator references, the first and second indicator
references being indicative of first and second conditions; and,
[0067] b) determining the likelihood in accordance with the results
of the comparison.
[0068] Typically the method includes: [0069] a) determining first
and second indicator probabilities using the results of the
comparisons; and, [0070] b) combining the first and second
indicator probabilities to determine a condition probability
indicative of the likelihood.
[0071] Typically the first and second indicator references are
distributions of indicators determined for first and second groups
of a reference population, the first and second group consisting of
individuals diagnosed with the first or second condition
respectively.
[0072] Typically the method includes: [0073] a) obtaining a sample
taken from the biological subject, the sample including
polynucleotide expression products; and, [0074] b) quantifying at
least some of the polynucleotide expression products within the
sample to determine the pair of biomarker values.
[0075] Typically the method includes, determining the indicator at
least in part using a ratio of concentrations of the polynucleotide
expression products.
[0076] Typically the method includes: [0077] a) quantifying
polynucleotide expression products by: [0078] b) amplifying at
least some polynucleotide expression products in the sample; and,
[0079] c) determining an amplification amount representing a degree
of amplification required to obtain a defined level of each of a
pair of polynucleotide expression products; and, [0080] d)
determining the indicator by determining a difference between the
amplification amounts.
[0081] Typically the amplification amount is at least one of:
[0082] a) a cycle time; [0083] b) a number of cycles; [0084] c) a
cycle threshold; [0085] d) an amplification time; and, [0086] e)
relative to an amplification amount of another amplified
product.
[0087] Typically the method includes determining: [0088] a) a first
derived biomarker value by determining a difference between the
amplification amounts of a first pair of polynucleotide expression
products; [0089] b) a second derived biomarker value by determining
a difference between the amplification amounts of a second pair of
polynucleotide expression products; [0090] c) determining the
indicator by adding the first and second derived biomarker
values.
[0091] Typically the immune system biomarker is a biomarker of an
immune system of the biological subject that is altered, or whose
level of expression is altered, as part of an inflammatory response
to damage or pathogenic insult.
[0092] Typically: [0093] a) the at least two immune system
biomarkers have a mutual correlation in respect of the at least one
condition that lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; and, [0094] b) the
indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence, degree or prognosis of the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3.
[0095] Typically the mutual correlation range is at least one of:
[0096] a) .+-.0.8; [0097] b) .+-.0.7; [0098] c) .+-.0.6; [0099] d)
.+-.0.5; [0100] e) .+-.0.4; [0101] f) .+-.0.3; [0102] g) .+-.0.2;
and, [0103] h) .+-.0.1.
[0104] Typically each immune system biomarker has a condition
correlation with the presence, absence, degree or prognosis of the
at least one condition that lies outside a condition correlation
range, the condition correlation range being between .+-.0.3.
[0105] Typically the condition correlation range is at least one
of: [0106] a) .+-.0.9; [0107] b) .+-.0.8; [0108] c) .+-.0.7; [0109]
d) .+-.0.6; [0110] e) .+-.0.5; and, [0111] f) .+-.0.4.
[0112] Typically the performance threshold is indicative of an
explained variance of at least one of: [0113] a) 0.4; [0114] b)
0.5; [0115] c) 0.6; [0116] d) 0.7; [0117] e) 0.8; and, [0118] f)
0.9.
[0119] Typically the immune system biomarker value is indicative of
a level or abundance of a molecule selected from one or more of a
nucleic acid molecule and a proteinaceous molecule.
[0120] In some embodiments, the indicator is for determining a
likelihood of the subject having inSIRS or ipSIRS, and wherein the
method includes: [0121] a) determining a first pair of biomarker
values indicative of a concentration of polynucleotide expression
products of the PLA2G7 gene and PLAC8 gene; [0122] b) determining a
second pair of biomarker values indicative of a concentration of
polynucleotide expression products of the CEACAM4 gene and LAMP1
gene; and, [0123] c) determining the indicator using the first and
second pairs of biomarker values.
[0124] In some embodiments, the indicator is for determining a
likelihood of the subject having inSIRS or a healthy condition, and
wherein biomarker values are determined from at least one
inflammatory response syndrome (IRS) immune system biomarker in
each of first and second IRS immune system biomarker groups,
wherein: [0125] a) the first IRS immune system biomarker group
consists of polynucleotide and/or polypeptide expression products
from the following IRS immune system biomarker genes: NUMB, RAB27A,
USP3//LOC100130855, HIF1A, LBXCOR1//PIAS1//CALML4, SQRDL, C20orf74,
IL10RB, PARP4, DNTTIP1, MTMR6//LOC646482, LAMP2, MAPK1,
SERINC3//TTPAL, IGSF6//METTL9, RP2, C18orf32, LOC284757,
MTMR10//MTMR15, SLC12A6, LCP1, CHP, PRR13, C20orf177, ZFP106,
DICER1, PHF12, IFNAR1, BNIP2, UBE2A, NIN, MBD2//SNORA37, TM9SF2,
RAB8B, CLIP1, WAS, DNAJC3, CDADC1, KIAA0317, MED13L, INTS6, PDK3,
MYO5A, NUPL1, VEZF1, CUL4B, USP9X//USP9Y, RPS6KA3, IL17RA//CECR7,
ELF1, TMX4, TAOK1, ELMO2, STAT5B//STAT5A, PAN3//EEF1A1//CHCHD2,
SIPA1L1//SNORD56B//LOC145474//LOC283567, OSBPL1A, SYNJ1, U2AF1,
NPEPPS//TBC1D3F//LOC440434, AP1G1, SNTB2, ZNF230//ZNF222, LYRM1,
ME2, GALNT1, DYRK1A, ZMYM2, ARID4A, TOB1, DOCK11, ACTR10,
ZMYM5//ZMYM2, FNDC3A, NUFIP2, STRADA, SPG11//ISLR,
SPATA13//C1QTNF9, BRWD3, BACH1, CLTC, LIG4, C21orf41//BACH1, KPNB1,
DHRS7, USP8, LACTB, SYNE2, ZDHHC20//LOC728099, EAPP,
MED13//LOC100129112, TAOK3, NLGN3, CIT, RIPK3, CP110, ABHD2, GNA13,
GGNBP2, PXN and PTPN1 (hereafter referred to interchangeably herein
as "group A IRS immune system biomarker genes" or "group A IRS
biomarker genes"); and [0126] b) the second IRS immune system
biomarker group consists of polynucleotide and/or polypeptide
expression products from the following IRS immune system biomarker
genes: AGFG1, BMX//HNRPDL, MCM5, TRIM28, GRWD1, ZNF574, ARRDC2,
PELP1, SHPK, GPS1, FAM38A, FBXO31, C16orf58//LOC100128371, NLRC3,
JMJD8, CDK10, TRAPPC2L, PRMT7, BRF1, MTA1/LOC647310//LOC100128343,
PLD4, DDX54//CCDC42B, PLBD1, IRAK3, FGD4, ARG1, RANGAP1, UNC84B,
SAMSN1//LOC388813, PFKL, S100A12, KIF22, LRRN1, CCDC134, LZTR1,
GZMM, ICAM2, TMC8,
LAT//SPNS1//NPIPL2//LOC728741//LOC730153//NPIPL3//SPIN1//LOC728888//LOC
100289169//LOC728734//LOC729602//LOC100288442//LOC100288332,
CLEC4D, CDK5RAP1, PPP1R16B, DAZAP1, LMF1, EDC4, IL21R//LOC283888,
JMJD7-PLA2G4B//JMJD7//PLA2G4B, TMEM120B//RHOF, ENTPDH/C10orf131,
ACSL1, ZC3H7B, CHERP//C19orf44//CALR3, U2AF2, PYGL, SOS2, ANKRD22,
MEGF9, MGAM//LOC100124692, IL1R2, IL2RB, FCAR, IL27RA, DHX37,
PATZ1, PRDM15, NOSIP, RPTOR, SPG7, DNAJA3, VNN1, SEPT9, THAP11,
LPCAT2, MAN2C1, PITPNM2, NOC2L//SAMD11//LOC401010, ZMYM3, FTSJ1,
KCNE1, ACTR5, FAM110A, FAM134C, LLGL2, INF2, KDM2B, ACSL4, B4GALT5,
CD79B, BCL11B, ERLIN1, TLR4, EVL, SRGN, SLC37A3, GPR141, MSL3,
MMP9//LOC100128028, MAP2K6, PHTF1, KLHL36, POLR3E, PCNX, PNKP,
TMEM104, TRPV2, SEPT1, APH1B, POLE, MED24, MPI, C12orf49, PES1,
ERCC1//CD3EAP, CD177, CPD, MEF2A//LYSMD4, C14orf43, RPLP0, CDC25B,
SYMPK, ARHGEF18//LOC100128573, PSTPIP2,
HERC2//HERC2P2//HERC2P3//LOC440248, MAPK14, F5, PLCG1, ZNF416,
AARS, KLHL2, APOBEC3A//APOBEC3B, CMTM1/CKLF, USP11,
MAP3K14//LOC100133991, GOLGA3, TMEM204, S100A8, IL1R1, DHPS,
PPP2R1A, UBTF, DRG2, DNMT1, USP36, ZBTB4, TSC2, KIAA0195, KIAA0182,
ALOX5AP, TGIF2, ST20//C15orf37, FN3KRP, ABCD4, ZFP64, NEO1,
PPIL2//YPEL1, RNPS1, NF2, SERPINB1, DDX51, PRPF6, TIMM22,
SYS1//SYS1-DBNDD2//DBNDD2, RAB31, KRI1, SMARCA4, CLUAP1, C16orf67,
C20orf4, CHTF8//HAS3, NPTN, CSRP2BP, AES, ODZ1, MTMR15//MTMR10,
SIRPD, EEF2//SNORD37, DKC1/SNORA36A//SNORA56, CEACAM4, C12orf43,
RANBP3, EEF2K, LOC338799, PLP2, AKAP8, ELAC2, AKAP1, TBC1D4, ALOX5,
WSB1, BAZ1A, ETS2, GGA2, CSTF2//RAD21, METTL9, GYG1, CRAMP1L//HN1L,
EVI2B, PPP1R13B, POPS, C20orf3, WDR59, KCNJ15, PGLYRP1, ELAVL1,
SLC25A1, PSMD3, CDC42EP3, FTSJ3, C2CD2, RBM19, CDH26, TRMT2B,
GTF2F1//LOC100130856,
SNRPN//SNURF//IPW//SNORD116-16//SNORD116-18//SNORD116-21//SNORD116-22//SN-
ORD116-17//SNORD116-19//PAR5//PAR-SN//SNORD
116-2//SNORD116-25//SNORD116-26//SNORD107//SNORD115-12//SNORD115-5//SNORD-
115-6//SNORD115-9//SNORD116-11//SNORD116-12//SNORD116-13//SNORD116-28//SNO-
RD116-4//SNORD64//PAR1//SNORD109A//SNORD109B//SNORD116-6//SNORD116-3//SNOR-
D116-9//SNORD115-13//SNORD115-1//SNORD115-14//SNORD115-15//SNORD115-21//SN-
ORD115-10//SNORD115-7//SNORD115-16//SNORD115-40//SNORD115-42//SNORD115-11/-
/SNORD115-29//SNORD115-34//SNORD115-36//SNORD115-4//SNORD115-43//HBII-52-2-
4//SNORD116-5//SNORD116-7//SNORD115-26//SNORD115-30//SNORD116-15//SNORD116-
-8//SNORD115-2//SNORD115-39//SNORD116-14//SNORD116-20//SNORD115-8//SNORD11-
5-3//SNORD115-38//SNORD115-41//SNORD115-22//SNORD115-44//SNORD116-1//SNORD-
115-17//SNORD115-18//SNORD115-19//SNORD115-20//SNORD116@, SLC9A8,
RPA1, ADARB1, AFG3L2, MCTP2, DACH1, SEH1L, RRP1B, ZNF335, WDR73,
TAF15, MOSPD2, WIPIMARSG, ARRB2, PLIN5ARG1, SNRPD3//C22orf13,
CTNNBL1, ZNF175, NCF4, DDX27, FBXO21, TDP1, ATXN2L, ILF3, VAPA,
DDX19B//DDX19A, NCOR2, KL, MTHFS, TOM1L2//LOC246315, APOBEC3D,
EXD2, CDR2//RRN3//LOC100131998//LOC653390, ADCY4, DHX33, CKLF,
GTF3C1, PRKCSH, DHX35, HSPH1, CCDC92, BCOR, CCPG1//PIGB//DYX1C1,
MCM3AP, FPR1, ZNF460, AKAP8L, DCAF7, RNF24, NSMCE1, PDHA1,
SAFB2//SAFB, ITM2B, ZNF236, PI4KA//PI4KAP1//PI4KAP2//LOC100293141,
CSTB, C14orf138, ITGAL, ARID3A, COG7, TYROBP, HP//HPR,
SRCAP//SNORA30, COG1, GK//GK3P//FTL//LOC652904, C15orf63//SERF2,
SERPINA6, SMG6//C17orf6, INO80, C16orf62, RAB35, PEF1, C14orf101,
TMEM185A, LIMK2, CTCF, DIABLO//B3GNT4, VPS33A, UNQ1887,
TBCB//POLR2I, ABHD13, SLC24A6, EDNRB, CAl2, ANAPC5, TMC3, TRIAP1,
ABHD12B, TDRD9, EIF2B1, CXorf59,
LRRC37A3//LRRC37A2//LRRC37A//ARL17P1//LRRC37A4//LOC100294335//LOC
644397, SDS, SYCP2, TBC1D8B, TMEM31, GUCY1B2, PFN1, SLC24A3,
ABCC11//LONP2 and ZNF257//ZNF492//ZNF99//ZNF98//LOC646864
(hereafter referred to interchangeably herein as "group B IRS
immune system biomarker genes" or "group B IRS biomarker
genes").
[0127] In some embodiments, the indicator is for determining a
likelihood of the subject having ipSIRS or a healthy condition, and
wherein biomarker values are determined from at least one IRS
immune system biomarker in each of first and second IRS immune
system biomarker groups, wherein: [0128] a) the first IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: LTBP3, LPHN1, NR1D1//THRA, METTL9, PLD4,
MAPK14, FAM102A, MYBBP1A//SPNS2, FLJ10232, SEMA4C, LMF1, PLBD1,
MAN1C1, B4GALT5, ENGASE, NDRG2, TLR5, WDR4, PATZ1, CD177, LILRA5,
SIRPD, ADAMTS10, TCF7, GGT7, GYG1, CDAN1, BRF1, GPR84,
TMC6//LOC100131096, PGAP3, GRAP//SNORD3B-1//SNORD3B-2//LOC400581,
SHPK, NOG, PVRIG//PILRB//STAG3, TDRD9, TMC8, C14orf21, NLRC4,
APBA2, TBL3, LDOC1L, C16orf58//LOC100128371, KLHL3, IRAK3,
JMJD7-PLA2G4B//JMJD7//PLA2G4B, RAB31, IL10RB, NFATC1//LOC100127994,
S100A12, SLC2A3//SLC2A14, GPA33, PLXDC1, BCL6//LOC100131635,
GTPBP3, SQRDL, CD7, TMEM177//LOC100125918, FBXO31, CACNA1E, LILRA4,
FAM38A, UBE2J1, SBF1//SBF1P1, TMEM204, FCAR, CDK4/MARCH9/C3HC4,
ZBTB4, PIWIL4, RNASE2//LOC643332, PRMT7, AGFG1, CMTM1/CKLF, MCTP1,
ARL11, FMNL3//PRPF40B, FAM151B, BAHD1, OSBPL7, ZAP70, TUBGCP6,
MAP2K6, NPTN, C3AR1, CD247, S100A8, TBCD, LMNB1/PCIF1, PFKL, GRWD1,
PYGL, UPP1, OMG, SAMSN1//LOC388813, BLCAP, PTPRS, FAM20A, CARD6,
SPPL2B, IL2RB, SORT1, BST1, TAF1C//ADAD2, SEMA4F, NCAPH2, MCTP2,
ZAK, CCR7, MAN2C1, NEURL4//GPS2//D4S234E, BMX//HNRPDL, TRAPPC6A,
LPCAT2, C19orf60, SLC4A10, C14orf101, TP53I3, IL1RN, AIM2, UBE2R2,
PNKP, ZNF70, SEPT1, NEO1, MPRIP, DPH1//OVCA2, C16orf67, CD58,
RAB27A, EEF2K, CLIC1, MBLAC2, IFNGR2, CRTC1//MAML2, CACNB1, GALNT3,
C19orf6, C20orf74, RALB, GPRASP1, CA4, ETS2, RP2, MARS2, RAB32,
FAIM3, C20orf24//SLA2, ZNF549, PIGL, PHTF1, IL18R1, IPO4, ZFP106,
SLC12A4, DNTTIP1, S100A11, ZNF544, ATXN1, GNLY, MID2, BACH2, INF2,
ARFGAP1, MSL3, SOS2, ARL8A, PTPRJ//OR4B1, NAT9, RHOT2//FBXL16,
PNPLA1, DNAJC13, GNG5, FAM129C, PXK, C10orf119, BATF, LMO7, KLF2,
NRD1, CLCN7, GLA, CFLAR, SYCP2, IMAGE5303689, LPGAT1, PTGDR, LAMP2,
ZNF607, INSL3//JAK3, DUSP3, PCNX, CD79B, IRAK1, ZNF550//ZNF549,
LOC100130950, SPTLC2, CTSA, RAP2C, ADCY9, MED12L, MTHFD2, CAP1,
TOR1AIP2//TOR1AIP1//IFRG15, CHP, TSEN2, LYRM1, UBE2A, NUPL1, YIPF1,
FRMD3, KAL1, CLTC, FLVCR2//RPS24, WSB2, KIAA0040, JAG1, GPR183,
N6AMT1, ZNF563, AP3B2, SERPINB2//SERPINB10, CDH2, ITFG1, EDEM2,
RNF135, HPSE, DSC1, FOXN2, RASSF2, ZNF420, ZFP28, UBE2G2//SUMO3,
PTTG1IP, PRKCB, KIT, PLEK, MAP4K4, GBA//GBAP, CLIP1, EDEM3,
SERINC3//TTPAL, TPST2, HNRPLL, TP53BP2, KCND1, GCLM, RIT1, OSCAR,
DDX59, EDNRB, ELMO2, RRAGC, AFTPH, DCUN1D3//LYRM1, RSBN1, IFI30,
SNX1, PTPN1, SEP15, ARMCX5, ALAS1, NFKBIA,
STXBP2//L00554363//LOC100131801, C15orf24, SRI, ASGR2,
NSF//LOC728806, TRIM69, SEC23A, PLAUR,
RAB3GAP2//AURKAPSH/AURKA//SNORA36B, MAOB//NAT13, DEDD, SEC23B,
COPA, EGF, STRADA, SIAE, C5, SLC30A1, ANXA4, NKG7, ABHD12B, TESK2,
LONRF3, PIKFYVE, SH3BGRL3, ARMCX3, NEU1, SPAST, STX6//KIAA1614,
TADA3L, LIN37//PSENEN, UBR3, WDR90, RTN2 and TMUB2 (hereafter
referred interchangeably herein as "group C IRS immune system
biomarker genes" or "group C IRS biomarker genes"); and, [0129] b)
the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from the
following IRS immune system biomarker genes: CNNM3, SLC25A45,
UNC84B, ARHGEF18//LOC100128573, PIK3IP1, EPHX2, SEPT9, ITPKB,
TSPYL2//GPR173, GALT, USP11, CBX7//LOC100128400,
MAP3K14//LOC100133991, CDK5RAP1, KLHL36, SPG7, ZNF574, RASA3,
KLHL22//KRT18, PYGO2, USP36, LCK, SKI, C5orf45//SQSTM1,
PIK3C2B//LOC100130573, ANGEL1, ZCCHC14, CIRBP, ZMIZ2,
TMEM120B//RHOF, NOC2L//SAMD11//LOC401010, PPP1R13B, ZNF416, PBXIP1,
SMYD5//NOTO, ZNF529, EDC4, LENG8, TBC1D22A//LOC100289878, CORO7,
COG8//PDF, CUL9, RASGRF2, CHERP//C19orf44//CALR3, POLR3E, CNNM4,
TSC2, XYLT2//LOC100130580, TP53, LMBR1L, AKT1, SLC7A6//SLC7A6OS,
LDLRAP1, SGSM2, ZNF764//ZNF747, AKAP1, RNPS1, ICAM2, KIF3A, TGIF2,
VAC14//LOC100130894, CXXC5, DCAF15, TARBP1, RCAN3, IMP4, LUC7L,
SIN3B, TRMT2B, POFUT2, AXIN1, PPIL2//YPEL1, NLRP1//LOC728392,
TMEM63A, TMEM208, ZNF362, GNG7, CASS4, ZNF287, DGKE, CEP68, ASXL1,
CLUAP1, WDR89, CD40LG, MGC57346//C17orf69, PPIE//CCDC25, FCHO1,
TNPO2//SNORD41, CSNK1E//LOC400927, CLYBL, XAB2, METT10D//LOC284009,
PRPF6, AKAP8, SH3BP1//PDXP, TOM1L2//LOC246315, ZNF329, ZNF274,
FAM119A, SMYD3, UNC84A//C7orf20, ZNF256, PSD4, CCDC130,
LIMD2//MAP3K3, ELP2, ZNF8, AFG3L2, TXK, DDX27, FBXL12, TNRC6C,
TADA1L, KIAA0355//FLJ21369, ZNF211, ZNF808//ZNF578//ZNF611,
SRCAP//SNORA30, BANP//RUNDC2C, ADARB1, CCDC71, KTI12, TCF25,
XYLTH/LYRM2//ZC3H11A, DET1, ABCF3, PRKCZ, KIAA0141, CHI3L1,
RPGRIP1, TTC31, MTMR15//MTMR10, MEF2D, TMEM50B, GLOD4, PRPF8,
C14orf43, P2RX5, MSH2, PCCA, DENND4B, SLC43A2, MAPK8IP3, TUBGCP5,
C19orf2, SEH1L, CCDC104, TRIM62, TDRKH, COG1, POLR1B, AFG3L1, TYK2,
RBM3, UBTF,
RP11-9412.2//NBPF16//NBPF11//NBPF15//NBPF8//NBPF20//NBPF10//NBPF14//NBP
F1//LOC100288142//NBPF12//KIAAl245//LOC100290137, ZNF41, ZNF461,
PI4KA//P14KAP1//PI4KAP2//LOC100293141, THEM4, BCL11A, CC2D1B,
WDR73, BBS2//OGFOD1, RRN3//LOC653390//LOC730092//LOC100131998,
NOP58, NUCKS1, ZNHIT6, RXRB, AKT3, FANCM, ERN1, FAM117B,
COX11//TOM1L1, ACVR2A, RP3-402G11.5, AHCTF1, CLN8, NVL, SAPS2,
DPEP3, PDE3B, DPEP2, GGA1, CCDC50,
SNRPN//SNURF//IPW//SNORD116-16//SNORD116-18//SNORD116-21//SNORD11-
6-22//SNORD116-17//SNORD116-19//PAR5//PAR-SN//SNORD116-2//SNORD116-25//SNO-
RD116-26//SNORD107//SNORD115-12//SNORD115-5//SNORD115-6//SNORD115-9//SNORD-
116-11//SNORD116-12//SNORD116-13//SNORD116-28//SNORD116-4//SNORD64//PAR1//-
SNORD109A//SNORD109B//SNORD116-6//SNORD116-3//SNORD116-9//SNORD115-13//SNO-
RD115-1//SNORD115-14//SNORD115-15//SNORD115-21//SNORD115-10//SNORD115-7//S-
NORD115-16//SNORD115-40//SNORD115-42//SNORD115-11//SNORD115-29//SNORD115-3-
4//SNORD115-36//SNORD115-4//SNORD115-43//HBII-52-24//SNORD116-5//SNORD116--
7//SNORD115-26//SNORD115-30//SNORD116-15//SNORD116-8//SNORD115-2//SNORD115-
-39//SNORD116-14//SNORD116-20//SNORD115-8//SNORD115-3//SNORD115-38//SNORD1-
15-41//SNORD115-22//SNORD115-44//SNORD116-1//SNORD115-17//SNORD115-18//SNO-
RD115-19//SNORD115-20//SNORD116@, C17orf65//ASB16, ZNF317,
SNRNP200, CXorf26, MTBP, NOL11//SNORA38B, CCNL2, ALDOC, PITPNC1,
FASTKD2, ZZZ3, PIK3R5, WDR82, GLDN, CHML, C15orf40, DIDO1,
CLCC1//GPSM2//C1orf62, SLC35D1, SCRN1, C15orf63//SERF2, ZNF460,
SAFB2//SAFB, C16orf54, DDX18, CTPS2, ZNF382, ZNF101, LIPT
1//MRPL30, ITGA6, KIF21B, INPP5B, SF3A1//CCDC157, ODF2L, NUAK2,
CHCHD5, AHSA2//USP34, YLPM1, TERF2, ZNF830, MAN2B1//MORG1, GPATCH8,
SHC1, SEPT4, SFRS2, TMC3, OTUD5, NARG1L, MKL1//KIAA1659, YTHDF1,
SLC14A2, GGA3 and EXOC7 (hereafter referred to interchangeably
herein as "group D IRS immune system biomarker genes" or "group D
IRS biomarker genes").
[0130] In some embodiments, the indicator is for determining a
likelihood of the subject having inSIRS or ipSIRS, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0131] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from the following IRS immune system biomarker genes:
ALKBH5//FLJ13773, RPS19BP1, RFXANK//MEF2B//LOC729991, NA, CDC6,
C19orf56, NA, ABCC2, THAP11, RTN2, MAZ, TAX1BP3, NUTF2, MPZL3,
FBXW5, HIST1H2BM, CETP, PQLC1, H2AFX, KIAA0101//CSNK1G1, STK17B,
SMARCD3, LOC100134934//CDK3, LPCAT4, LPP, MPZL2, ANKRD9,
PRR13//PCBP2, MDS2, RBM33, GATAD2B//PLIN2, PPTC7, MYBL2, OIP5,
PLA2G7, CRIPT, RNF186, CCDC125, TLE3, C3orf35, SAP130, MXD1, ZHX2,
CDK5RAP3, ENTPD1//C10orf131, NDUFB7, POGZ, DOK3, MCMI, IL17F, CLPS
and DUSP11 (hereafter referred to interchangeably herein as "group
E IRS immune system biomarker genes" or "group E IRS biomarker
genes"); and, [0132] b) the second IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from the following IRS immune system biomarker genes:
PIWIL4, C11orf82, ACRC, CLPTM1L, MAGED2, PLACE, ZDHHC4, OTX1,
INSIG1, BATF, MFSD11, DNASE1L1//RPL10, C15orf24, CDS2, KEAP1,
ARD1A, POLR2G, AHCY, SLC39A9, CUGBP1, FAM96B, TM7SF3, CTSZ, CD63,
SPPL2A, ST3GAL2, SEC13, TM9SF1, IRAK2, GOSR2, ADIPOR2, TG, GABRR2,
TPST2, DERL2, CCDC101//LOC388242, VWA5A//OR10D1P, CD300A, MRPS34,
PSMA7, MAPK6, JKAMP, TLR10, RAG1AP1, NEU1, SLC30A1, PDGFC, ATOX1,
CYBASC3, TMEM205//hCG.sub.--29977, FAM108B1, ACSS2, HIST1H4L,
AGTRAP, RNF114, UBQLN2, EDF1, C20orf197, UBE2E1, RER1, ANKRD10,
SEC22C, TM2D3, SLC15A2, TRIM28, COX15, CCDC109A, CSTF1, AIP,
ACTR1A, HIST1H4I, YIF1B, TSPAN31, VPS26B, CNIH, TGFBR1,
NIPA2//CYFIP1, DDAH2, BID, CYB5R1, CEACAM4, KIT, GAB2, JAG1,
RPGRIP1, VAT1, GNB5//LOC100129973, SSR4//IDH3G, LAMP1, MRPL41,
RUNX2, ITFG1, DNASE1, ZNRD1//NCRNA00171, NLRP1//LOC728392, STT3A,
MGAT4B//SQS.TM.1, KIAAl257//ACAD9//LOC100132731, KLHL6, PTPN6,
GALK2, DAD1//OR6J1, PDLIM5, TMEM147, TRAM1//LOC286190, LZTR1,
TNPO1, ACSL5, C22orf37, PLK1, SYNE2, PSMD3, FLJ27255, PRKCD, RAB34,
RPN2//EEF1A2, SLC35B1, KCNIP3, PDE3B, PXMP2//PGAM5, SDF2, HIST1H3I,
LOC284757, TMEM33//DCAF4L1, CSNK2A2, LSM10, PTTGlIP, ADRB3//GOT1L1,
PLXNA2, DIAPH2, BICD2, HAL, RPS6KC1, TMEM106C, CD1E, SLC35A5,
C7orf26, IMP3, PICALM, ARF1, FHOD1//SLC9A5, C19orf55,
TOMM40L//NR1I3, INSIG2, NEK9, HCG27, SDHB, CUBN, PRDX3,
CEPT1//DRAM2, ERGIC1, KPNA3, VAV1, ELM01, CUGBP2, LASP1, COL9A2,
MEGF9, ELF4, SUZ12P, SULT1A2//SULT1A1, FAM123C, FAR2, IER2, RGS2,
MYBPH, MFAP3, RCHY1, MGAT1, MFSD4, CDH2, TMEM184C, CTRB2//CTRB1,
MPP4, PHF12, SLBP, ADAM19, HTR1B, TRIM55, CRNN, KLHDC7A, YIPF5,
SLC11A1, GABBR1, CAMKV, SLC35F5, CHRNG, CXCL14, METTLE, PHC2,
GPR153, TNFRSF10D, BAT2L, GALNT2, DENND3//C8orf60, CLDN3, F11,
CCDC93, FLJ46365, CYP21A2, ETV5, TRPM2, IL20, NBL1//Clorf151, NGEF,
POU6F2, PTEN//PTENP1, NPC1L1, CYP4B1, NFIC, PPARGC1A, PLIN3, THPO,
TIMP4, CELSR2, DMBX1, CAMK2B, PPFIA1, HCLS1, SLC6A20,
C17orf66//RSL24D1, PIWIL2, DAZL//DAZ4//DAZ3//DAZ2, GAL3ST2,
TPD52L1, C19orf34, RASGEF1C, BAALC//FLJ10489, NR4A2//FLJ46875,
HAPLN1, CLDN18, TAS1R1, TIMD4, SKI, CCDC48, MEGF10, OSBPL6, DNAH2,
ARID1B, PGC, DCST1, SDK1, CHIA, REG4//NBPF7, TMEM49//CLTC//MIR21,
TMEM44, NDUFB6//DFFB, COL25A1, EPHX4, NCRNA00085, NTRK3, PKHD1,
SLC2A7, NTRK1, ABHD1//PREB, SLC4A9, GPNMB, SLC5A1, SLC7A8, RTCD1,
PROC, C17orf64, FLJ14100//Clorf86, NUP50, UNKL, C10orf18, TMEM61,
C9orf68, CYTSA, MORN3, RAB17, CNNM3, CCDC28B, SH2D6, BARHL2, T,
SNRK, TCP11, KDR, ENAM, UNKL, SPRR2C, GPR17//LOC100291428//LIMS2,
Clorf175//TTC4, CACNA1D, C2orf62, LOC100132686, UNQ6126, TRIM15,
GPR113//SELI, IL22, SCN10A, FAAH, MBOAT7, C7orf51, KIAA1530, TRPM8,
C1orf95, DDC//LOC100129427, GABRA1, HCRTR1, DCST2, CHODL,
PANS//EEF1A1//CHCHD2, LYPD6B, UGT3A1 and SERPINA6 (hereafter
referred to interchangeably herein as "group F IRS immune system
biomarker genes" or "group F IRS biomarker genes").
[0133] In some embodiments, the indicator is for determining a
likelihood of the subject having inSIRS or ipSIRS, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first, second, third and fourth IRS immune
system biomarker groups, wherein: [0134] a) the first IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: RPS19BP1, RFXANK//MEF2B//LOC729991,
C19orf56, RTN2, HIST1H2BM, CETP, PQLC1, H2AFX, KIAA0101//CSNK1G1,
LOC100134934//CDK3, LPCAT4, LPP, MPZL2, ANKRD9, RBM33, MYBL2,
PLA2G7,01P5, CRIPT, RNF186, C3orf35, ZHX2, NDUFB7 and DUSP11
(hereafter referred to interchangeably herein as "group G IRS
immune system biomarker genes" or "group G IRS biomarker genes");
[0135] b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from the
following IRS immune system biomarker genes: PIWIL4, C11orf82,
ACRC, PLACE, ZDHHC4, OTX1, INSIG1, BATF, MFSD11, C15orf24, CDS2,
POLR2G, SLC39A9, FAM96B, TM7SF3, SPPL2A, ADIPOR2, GOSR2, DERL2,
TPST2, VWA5A//OR10D1P, CCDC101//LOC388242, MAPK6, PSMA7, JKAMP,
TLR10, RAG1AP1, SLC30A1, PDGFC, ATOX1, TMEM205//hCG29977, FAM108B1,
UBQLN2, EDF1, C20orf197, RER1, UBE2E1, ANKRD10, SEC22C, TM2D3,
SLC15A2, CCDC109A, HIST1H4I, TSPAN31, TGFBR1, CNIH, DDAH2,
NIPA2//CYFIP1, BID, CYB5R1, KIT, RPGRIP1, MRPL41, RUNX2, ITFG1,
ZNRD1//NCRNA00171, NLRP1//LOC728392, KIAA1257//ACAD9//LOC100132731,
KLHL6, GALK2, DAD1//OR6J1, PDLIM5, TRAMH/LOC286190, TNPO1, ACSL5,
SYNE2, RPN2//EEF1A2, SLC35B1, KCNIP3, TMEM33//DCAF4L1, CSNK2A2,
LSM10, PLXNA2, DIAPH2, HAL, RPS6KC1, SLC35A5, PICALM, C19orf55,
INSIG2, SDHB, PRDX3, CEPTH/DRAM2, KPNA3, SULT1A2//SULT1A1, FAR2,
MYBPH, MFAP3, RCHY1, CDH2, TMEM184C, CTRB2//CTRB1, SLBP, CRNN,
YIPF5, CHRNG, SLC35F5, METTLE, CLDN3, CCDC93, CYP21A2,
NBL1//Clorf151, NGEF, POU6F2, NPC1L1, PPARGC1A, THPO, CELSR2,
DMBX1, SLC6A20, C17orf66//RSL24D1, GAL3ST2, C19orf34,
BAALC//FLJ10489, CLDN18, TAS1R1, CCDC48, OSBPL6, SDK1,
TMEM49//CLTC//MIR21, TMEM44, NDUFB6//DFFB, NCRNA00085, NTRK3,
NTRK1, SLC4A9, SLC5A1, RTCD1, FLJ14100//C1orf86, PROC, C17orf64,
UNKL, C9orf68, MORN3, RAB17, CNNM3, CCDC28B, BARHL2, UNKL,
LOC100132686, UNQ6126, IL22, FAAH, C7orf51, DCST2, LYPD6B and
SERPINA6 (hereafter referred to interchangeably herein as "group H
IRS immune system biomarker genes" or "group H IRS biomarker
genes"); [0136] c) the third IRS immune system biomarker group
consists of polynucleotide and/or polypeptide expression products
from the following IRS immune system biomarker genes:
ALKBH5//FLJ13773, RNA243, ARD1A, CDC6, AHCY, MRPS34, CYBASC3,
HIST1H4L, RNF114, TRIM28, CSTF1, CEACAM4, GAB2, GNB5//LOC100129973,
THAP11, SSR4//IDH3G, STT3A, NUTF2, MPZL3, TMEM147, RAB34, PDE3B,
PXMP2//PGAM5, HIST1H3I, LOC284757, TMEM106C, STK17B, IMP3, HCG27,
CUBN, ERGIC1, ELM01, CUGBP2, COL9A2, MEGF9, SUZ12P, FAM123C, RGS2,
PRR13//PCBP2, PHF12, ADAM19, GATAD2B//PLIN2, SLC11A1, PPTC7, PHC2,
BAT2L, DENND3//C8orf60, FLJ46365, ETV5, CCDC125, PTEN//PTENP1,
TLE3, NFIC, TIMP4, PPFIA1, HCLS1, SAP130, MXD1, NR4A2//FLJ46875,
SKI, ARID1B, ENTPDH/C10orf131, POGZ, DOK3, REG4//NBPF7, MCMI,
SLC7A8, NUP50, C10orf18, TMEM61, SH2D6, SNRK, SPRR2C, CACNA1D,
TRIM15, CLPS, MBOAT7, KIAA1530, C1orf95, GABRA1, HCRTR1, CHODL and
PAN3//EEF1A1//CHCHD2 (hereafter referred to interchangeably herein
as "group I IRS immune system biomarker genes" or "group I IRS
biomarker genes"); and, [0137] d) the fourth IRS immune system
biomarker group consists of polynucleotide and/or polypeptide
expression products from the following IRS immune system biomarker
genes: CLPTM1L, MAGED2, DNASE1L1//RPL10, KEAP1, CUGBP1, CTSZ, CD63,
ST3GAL2, SEC13, TM9SF1, IRAK2, GABRR2, TG, CD300A, NEU1, ACSS2,
AGTRAP, UPF0627, COX15, ABCC2, ACTR1A, AIP, YIF1B, VPS26B, JAG1,
VAT1, LAMP1, DNASE1, MAZ, TAX1BP3, MGAT4B//SQSTM1, FBXW5, PTPN6,
LZTR1, PLK1, C22orf37, PSMD3, FLJ27255, PRKCD, SDF2, PTTG1IP,
ADRB3//GOT1L1, BICD2, CD1E, C7orf26, ARF1, FHOD1//SLC9A5,
TOMM40L//NR1I3, NEK9, VAV1, SMARCD3, LASP1, ELF4, IER2, MGAT1,
MFSD4, MDS2, MPP4, HTR1B, TRIM55, KLHDC7A, GABBR1, CAMKV, CXCL14,
GPR153, TNFRSF10D, GALNT2, F11, IL20, TRPM2, CYP4B1, PLIN3, CAMK2B,
PIWIL2, DAZL//DAZ4//DAZ3//DAZ2, TPD52L1, RASGEF1C, HAPLN1, TIMD4,
CDK5RAP3, MEGF10, DNAH2, PGC, DCST1, CHIA, COL25A1, EPHX4, PKHD1,
SLC2A7, ABHD1//PREB, GPNMB, CYTSA, T, TCP11, ENAM, KDR,
GPR17//LOC100291428//LIMS2, Clorf175//TTC4, IL17F, C2orf62,
GPR113//SELI, SCN10A, TRPM8, DDC//LOC100129427 and UGT3A1
(hereafter referred to interchangeably herein as "group J IRS
immune system biomarker genes" or "group J IRS biomarker
genes").
[0138] In specific embodiments, the first IRS immune system
biomarker is a PLA2G7 expression product, the second IRS immune
system biomarker is a PLAC8 expression product, the third IRS
immune system biomarker is a CEACAM4 expression product and the
fourth IRS immune system biomarker is a LAMP1 expression
product.
[0139] In some embodiments, the indicator is for determining a
likelihood of the subject having mild sepsis or severe sepsis, and
wherein biomarker values are determined from at least one IRS
immune system biomarker in each of first and second IRS immune
system biomarker groups, wherein: [0140] a) the first IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: N4BP2L2//CG030, FAM96A, MINPP1,
MORC3//DOPEY2, LSM8, PLEKHA3, MITD1, ATF4, B2M, TMX3, ZNF273,
PLEKHF2, UNQ2999, DPM1, OCLM, NADK, GPR65, SFRS3, ZNF28, PFDN4,
COQ10B, SLC30A6//DDX50, KPNA5, ATP6V1G1, HAUS2, hCG.sub.--2039148,
RAB33B, BET1, UBE2V2, ATP6AP2, SUBH/TMEM183A, TMEM188, ABHD3,
LAPTM4A, RNF138, CCDC82, TMEM179B, PAPD4, VAMP2, CCDC126, ATG3,
CHCHD5, RBM39//LOC643167, NAT8B, HAT1, CNOT6L, ZBED5, GOLT1B,
TTC33, ACTN1, ACTR6, GNB4, TMEM208, CCNH, C4orf34, HAUS6//SCARNA8,
TCTN1, SF3B14, TMEM138, TTC35, DLEU2//DLEU2L, MFSD8, COX7A2L,
UGGT2, CEPTH/DRAM2, LEMD3, CREBZF, RPL21P44, ANGEL2, UFM1, XP01,
CALM2//C2orf61, PLDN, CLK1//PPIL3, Clorf84, PPA2, FPGT//TNNI3K,
ORC4L, SLC25A14, H3F3B//H3F3C, FAM188A, MCM9, KLHL9, NACA,
PAFAH1B2, CRLS1, TSSK4, LOC152217, ZNF568, ATP6V0D1//LOC100132855,
CDC37L1, FNTA, SHFM1, JKAMP, TMEM126B, MRPL47, DENND1B,
ATP6V0E1//SNORA74B, LIN7C, HAUS3//POLN, SLC30A7, VAMP3, OBFC2A,
MAGT1, STARD3NL, C5orf15, PSMD10, RERE, RNF139, SFT2D2, SKP1,
RNPC3//AMY2B, MYOM1, TIPRL, HPRT1, TRIM21, VRK2, CDKN1B, ANKRA2,
RAP2B, FAM127B//FAM127C//FAM127A, FAM126A, TMEM161B, UNQ1887,
FANCF, SELT, CYP20A1, RWDD1, ARPP19, SC5DL,
TICAM2//TMED7//TMED7-TICAM2, STAM, LEPROTL1, RNF44, DCP1B, TNNT3,
UCHL5, UPRT, SON, PIK3C3, SFRS1//FLJ44342, FBXO22//FBXO22OS, SCFD1,
Cllorf31, TMTC3, CCDC132, TMBIM4//LOC100133322, ATAD1, APH1A, MYNN,
HADHB, PIGN, RNA243, SLC38A9, C10orf84, CDKN1A, ATP7A, RPAP2,
ZNF451, GSK3B//LOC100129275, TMSB10, KCTD5//PRO0461//PDPK1, VPS29,
WIPF3//ZNRF2//LOC441208, SFRS5 and C11orf73 (hereafter referred to
interchangeably herein as "group K IRS immune system biomarker
genes" or "group K IRS biomarker genes"); and, [0141] b) the second
IRS immune system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: C13orf1, PRKCB, APOBEC3A//APOBEC3B, SFRS9,
NCAPD2//SCARNA10//FADS1, GATS, LOC284757, TSHZ2, JAK1, MAPK13,
RPN1, GNAS, CYTSA, TRPM6, C22orf30, PCMTD1//PXDNL, CCDC69, ARSD,
MLL3//BAGE2, NCORH/C20orf191//LOC100131704, MRPS7, VEZF1, GSR,
POU2F1, VPS4A, SMG7, PTP4A2, OSBP, GLCCI1thcag7.903, DOCK2, PCNX,
GLTP, FBXO18, YY2, TCF20, NR2C2//MRPS25, TEX2, BAMBI, WHSC1L1,
UBTF, FAH, GEMIN4, DDEF1IT1, FAM50A, VPS13D, SATB1//TBC1D5, PARP6,
SETD5, PHF21A, IRF4, ZNF217, UBE4A, HIVEP1, HDLBP, GNAI2, MED13L,
FOXP1, NSD1, DDOST, TMBIM6, ABLIM1, SYNRG//LOC100131822, KDM3B,
ASH1L, NCOA2, GPRIN3, NCOA1, KLF3, LOC100288114//MGC9913, VPS26B,
AHCYL1, CDC6, PLCG2, IL16, GIT2, TACC3, MAP4K4, NEK9,
FAM149B1//FAM149B2, VPS8, ATXN7, WDFY4, ZC3H11A//RP11-74E24.2,
THRAP3, ZNF346, AP3M2, CD14, CLASP1, ABCC2,
ATXN7L1//RINT1//EFCAB10, IN080D, CTPS,
LRRC37A3//LRRC37A2//LRRC37A//ARL17P1//LRRC37A4//LOC100294335//LO
C644397, DNASE1, LRRN3, ZNF318, PRKAR2A, MRPS15,
ANKHD1-EIF4EBP3//ANKHDP/EIF4EBP3, BTF3L4, DGKA, C10orf119, MBD5,
Cllorf30, CDC2L5, DPP4, DCTN4, TP53BP2, IMPDH2, GOT2, ELMO1and
PARP1 (hereafter referred to interchangeably herein as "group L IRS
immune system biomarker genes" or "group L IRS biomarker
genes").
[0142] In some embodiments, the indicator is for determining a
likelihood of the subject having mild sepsis or septic shock, and
wherein biomarker values are determined from at least one IRS
immune system biomarker in each of first and second IRS immune
system biomarker groups, wherein: [0143] a) the first IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: EEF1DP3, GIMAP7, ZNF839, PYGL, TNFAIP8L2,
SFRS9, VIM, GLTP, WDFY4, APPL2, C4orf3, PLD1, LIN7A, ELP2, ZDHHC3,
UBAPP/K1F24, C20orf177, FAM149B1//FAM149B2, E2F3, SPATA1, DACH1,
FAM47E//STBD1, SVIL//hCG1783494, METTL9, LRRC42, NUPL1, UPP1, AFF2,
SLC16A4, SET, CA4, HCK, C16orf72, EXT1, NOP58, FRZB,
C9orf6//IKBKAP, VASP, ASB8//PHB, GTDC1, SLC39A9, FBXO34//KIAA0831,
RABGEF1//tcag7.967//tcag7.951//KCTD7//LOC10029333 3, SLC28A3,
WIPIMARSG, NFE2, GOLGAH/SCAI, C9orf84, RPS6KA2, PSMA7, C19orf59,
ICA1, TOR1AIP2//TOR1AIP1//IFRG15, MSRA, FPR1, TP53I3, FOXL2, CD63,
PIGC, CENPBD1, CYB5R1, GNB2, ZNF197, KLF7, NSFL1C, USF2, PARP6,
MAP9, TSPO, CSTB, DDA1, SLC36A4, GFOD2, OCRL, ZNF232, APH1B,
TALDOP/INTS8, DENND2C//BCAS2, RAB11FIP2, LARS, PLP2, EIF4E2,
DNASE1L1//RPL10, AFTPH, TMCO3, RPA2, UQCRC1, ZDHHC3, and ACTR1A
(hereafter referred to interchangeably herein as "group M IRS
immune system biomarker genes" or "group M IRS biomarker genes");
and, [0144] b) the second IRS immune system biomarker group
consists of polynucleotide and/or polypeptide expression products
from the following IRS immune system biomarker genes: CD6, ITPA,
PVRIG//PILRB//STAG3, FLT3LG, IL12RB1, MAP3K14//LOC100133991,
FAM102A, TMC8, TMEM208, TMEM109, C1orf84, NADK, SEPT1, UBA7, CD5,
C12orf62, C20orf112, FOXP4, EIF4A2//SNORA4, ZNF487//LOC439911,
KCTD13, IL18BP//NUMA1, KPNA5, EDC4, ZNF587//ZNF417, NBR2, RPL28,
ZNF738, SHFM1, CNO, C9orf82, RPL5//SNORA66//SNORD21//FAM69A, VAMP2,
SIT1, SFRS3, LCK, IRF9, MRPS21, NEFM//LOC100129717, RCN2, BET1,
C19orf6, SH2D1A, GLS, OR1C1, RBM14//RBM4, CCDC97, TUT1, MRPL14,
ENOPH1, NAGK, DPM1, MPV17, SH2D3C, TMEM204, C3orf42, ARSD, FAM96A,
LSM8, ATP5G1, KTI12, ARL4C, C11orf31, C16orf58//LOC100128371,
CCDC109B//HIGD1A//CCDC13, NUDT21, ZFP106, ACTR6, LIX1L, MEF2D,
ZNF407, TMEM18, NAT11, DNAJC24, PLEKHA3, GPN2, SMCR7,
C7orf23//DMTF1, PPM1G, CNOT6L, NACA, FNTA, GRIA2, N4BP2L2//CG030,
ENOSF1/TYMS, THBS4, LUC7L2, MOCS2, ZNF383, AKNA, UBE2Z, FLJ34077,
SH3KBP1, POLR2F//LOC100131530, ILIA, UBE2V2, KIAA1919, PRKCB,
SHOC2, RBM46, GRPEL2, KCNG3, PCDH10, XAB2, VPS52, MCCC2, NSMCE4A,
PTP4A2, SNX2, COQ10A, C6orf182, RNF44, MOGS, DIRAS3, Mitochondrial,
KIAA1826, SGK196, NSUN5//NSUN5B//NSUN5C, Mitochondrial, MORF4L2,
MAK16//C8orf41, PILRB//PVRIG//STAG3, SAAL1, TMX3, PTPRG, MAPK1,
DNAJA3, LEAP2, LMOD3, ASB6, MTMR10//MTMR15, HIBADH, MORC1,
CORO1A//LOC606724, SFXN2, HSN2, AAAS, INHBA, MRPS7, LRRFIP1,
KCTD7//RABGEF1, DCDC2//KAAG1, SLCO3A1, DENND4B, CFTR, MOG, QRFPR,
BAT2//SNORA38, ITPR3, C3orf22, TNFRSF4, ZNF646//ZNF668, GCM2,
CDK4//TSPAN31, FXC1, RNMT, CHST4, POLR3E, PDE8B, C6orf146, CHCHD5,
TARBP1, TADA1L, PREX2, TRAP1//DNASE1, ZNHIT6, RGP1//GBA2, SMCP,
ZC3H15, TRAPPC4, SARNP//DNAJC14, GNAS, C14orf104, IL20RA, WAC,
SLIT3, C4orf39, TSEN54, PPP1R13B, TRIM35, HGC6.3, YIPF3,
HQ0644/PRO0644, FAM13C//PHYHIPL, BCCIP//DHX32, ACADM,
SUB1//TMEM183A, KPNA1, SPAG17//WDR3, KIAA1549, DIABLO//B3GNT4,
ZBTB44, EIF1AD, RUNX1T1, TRIL, PTPLB, DHDDS, UPK1A, OTUB1,
Clorf182, HAPLN2, SOBP, RYR3, LRRC17, TKTL2, TMBIM6, and GDNF
(hereafter referred to interchangeably herein as "group N IRS
immune system biomarker genes" or "group N IRS biomarker
genes").
[0145] In some embodiments, the indicator is for determining a
likelihood of the subject having severe sepsis or septic shock, and
wherein biomarker values are determined from at least one IRS
immune system biomarker in each of first and second IRS immune
system biomarker groups, wherein: [0146] a) the first IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: SIRPG//SIRPA, GATA3, FAM102A, UPF3A,
ATP13A5, CACNA1I and RANBP17//USP12 (hereafter referred to
interchangeably herein as "group O IRS immune system biomarker
genes" or "group O IRS biomarker genes"); and, [0147] b) the second
IRS immune system biomarker group consists of polynucleotide and/or
polypeptide expression products from the following IRS immune
system biomarker genes: GABRA6, HAPLN1, YSK4, FOXL2, TLL1, MECOM,
COL3A1, HRG, SLC22A3, C8orf45, SCN7A and SNTG1 (hereafter referred
to interchangeably herein as "group P IRS immune system biomarker
genes" or "group P IRS biomarker genes").
[0148] In another broad form the present invention seeks to provide
apparatus for determining an indicator used in assessing a
likelihood of a biological subject having a presence, absence,
degree or prognosis of at least one medical condition, the
apparatus including at least one electronic processing device that:
[0149] a) determines a pair of biomarker values, each biomarker
value being a value measured or derived for at least one
corresponding immune system biomarker of the biological subject and
being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject; [0150]
b) determines a derived biomarker value using the pair of biomarker
values, the derived biomarker value being indicative of a ratio of
concentrations of the pair of immune system biomarkers; and, [0151]
c) determines the indicator using the derived biomarker value.
[0152] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
first pair and a second pair of reverse transcribed mRNAs, wherein
the first pair comprises a PLAC8 reverse transcribed mRNA and a
PLA2G7 reverse transcribed mRNA and wherein the second pair
comprises a CEACAM4 reverse transcribed mRNA and a LAMP1 reverse
transcribed mRNA.
[0153] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group A IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group B IRS immune system biomarker genes.
[0154] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group C IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group D IRS immune system biomarker genes.
[0155] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group E IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group F IRS immune system biomarker genes.
[0156] In another broad form the present invention seeks to provide
a composition comprising at least two pairs of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least two pairs of reverse transcribed mRNAs comprising a
first pair and a second pair of reverse transcribed mRNAs, wherein
the first pair comprises a reverse transcribed mRNA from a first
IRS immune system biomarker gene and a reverse transcribed mRNA
from a second IRS immune system biomarker gene, and wherein the
second pair comprises a reverse transcribed mRNA from a third IRS
immune system biomarker gene and a reverse transcribed mRNA from a
fourth IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group G IRS immune
system biomarker genes, wherein the second IRS immune system
biomarker gene is selected from group H IRS immune system biomarker
genes, wherein the third IRS immune system biomarker gene is
selected from group I IRS immune system biomarker genes, and
wherein the fourth IRS immune system biomarker gene is selected
from group J IRS immune system biomarker genes.
[0157] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group K IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group L IRS immune system biomarker genes.
[0158] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group M IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group N IRS immune system biomarker genes.
[0159] In another broad form the present invention seeks to provide
a composition comprising at least one pair of reverse transcribed
mRNAs and at least one oligonucleotide primer or probe that
hybridizes to an individual one of the reverse transcribed mRNAs,
the at least one pair of reverse transcribed mRNAs comprising a
reverse transcribed mRNA from a first IRS immune system biomarker
gene selected from group O IRS immune system biomarker genes and a
reverse transcribed mRNA from a second IRS immune system biomarker
gene selected from group P IRS immune system biomarker genes.
[0160] The at least one oligonucleotide primer or probe can be
hybridized to an individual one of the reverse transcribed
mRNAs.
[0161] The reverse transcribed mRNAs can be derived from components
of the immune system.
[0162] The reverse transcribed mRNAs can be derived from
leukocytes.
[0163] The reverse transcribed mRNAs can be derived from blood
cells.
[0164] The reverse transcribed mRNAs can be derived from peripheral
blood cells.
[0165] The composition can further comprise a labeled reagent for
detecting the reverse transcribed mRNAs.
[0166] The labeled reagent can be a labeled said at least one
oligonucleotide primer or probe.
[0167] The labeled reagent can be a labeled said reverse
transcribed mRNA.
[0168] The labeled reagent can be a labeled oligonucleotide linker
or tag for labeling a said reverse transcribed mRNA.
[0169] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of inSIRS and ipSIRS, the kit comprising at least
one pair of reagents comprising a first pair of reagents and a
second pair of reagents, wherein the first pair of reagents
comprises (i) a reagent that allows quantification of a
polynucleotide expression product of the PLA2G7 gene; and (ii) a
reagent that allows quantification of a polynucleotide expression
product of the PLAC8 gene, wherein the second pair of reagents
comprises: (iii) a reagent that allows quantification of a
polynucleotide expression product of the CEACAM4 gene; and (iv) a
reagent that allows quantification of a polynucleotide expression
product of the LAMP1 gene.
[0170] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of inSIRS and a healthy condition, the kit
comprising at least one pair of reagents comprising (i) a reagent
that allows quantification of a polynucleotide expression product
of a first IRS immune system biomarker gene; and (ii) a reagent
that allows quantification of a polynucleotide expression product
of a second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group A IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group B IRS immune system biomarker
genes.
[0171] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of ipSIRS and a healthy condition, the kit
comprising at least one pair of reagents comprising (i) a reagent
that allows quantification of a polynucleotide expression product
of a first IRS immune system biomarker gene; and (ii) a reagent
that allows quantification of a polynucleotide expression product
of a second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group C IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group D IRS immune system biomarker
genes.
[0172] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of inSIRS and ipSIRS, the kit comprising at least
one pair of reagents comprising (i) a reagent that allows
quantification of a polynucleotide expression product of a first
IRS immune system biomarker gene; and (ii) a reagent that allows
quantification of a polynucleotide expression product of a second
IRS immune system biomarker gene, wherein the first IRS immune
system biomarker gene is selected from group E IRS immune system
biomarker genes and wherein the second IRS immune system biomarker
gene is selected from group F IRS immune system biomarker
genes.
[0173] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of inSIRS and ipSIRS, the kit comprising at least
two pairs of reagents comprising a first pair of reagents and a
second pair of reagents, wherein the first pair of reagents
comprises (i) a reagent that allows quantification of a
polynucleotide expression product of a first IRS immune system
biomarker gene; and (ii) a reagent that allows quantification of a
polynucleotide expression product of a second IRS immune system
biomarker gene, and wherein the second pair of reagents comprises
(i) a reagent that allows quantification of a polynucleotide
expression product of a third IRS immune system biomarker gene; and
(ii) a reagent that allows quantification of a polynucleotide
expression product of a fourth IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group G IRS immune system biomarker genes, wherein the second IRS
immune system biomarker gene is selected from group H IRS immune
system biomarker genes, wherein the third IRS immune system
biomarker gene is selected from group I IRS immune system biomarker
genes, and wherein the fourth IRS immune system biomarker gene is
selected from group J IRS immune system biomarker genes.
[0174] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of mild sepsis and severe sepsis, the kit
comprising at least one pair of reagents comprising (i) a reagent
that allows quantification of a polynucleotide expression product
of a first IRS immune system biomarker gene; and (ii) a reagent
that allows quantification of a polynucleotide expression product
of a second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group K IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group L IRS immune system biomarker
genes.
[0175] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of mild sepsis and septic shock, the kit
comprising at least one pair of reagents comprising (i) a reagent
that allows quantification of a polynucleotide expression product
of a first IRS immune system biomarker gene; and (ii) a reagent
that allows quantification of a polynucleotide expression product
of a second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group M IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group N IRS immune system biomarker
genes.
[0176] In another broad form the present invention seeks to provide
a kit for determining an indicator indicative of the likelihood of
the presence or absence of at least one condition selected from the
group consisting of severe sepsis and septic shock, the kit
comprising at least one pair of reagents comprising (i) a reagent
that allows quantification of a polynucleotide expression product
of a first IRS immune system biomarker gene; and (ii) a reagent
that allows quantification of a polynucleotide expression product
of a second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group O IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group P IRS immune system biomarker
genes.
[0177] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
inSIRS and ipSIRS, the method comprising: exposing the subject to a
treatment regimen for treating the at least one condition based on
an indicator obtained from an indicator-determining method, wherein
the indicator is indicative of the presence of the at least one
condition in the subject, the indicator-determining method
comprising: (a) determining at least one pair of biomarker values,
each biomarker value being a value measured or derived for at least
one corresponding immune system biomarker of the biological subject
and being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject, (b)
determining at least one derived biomarker value using the at least
one pair of biomarker values, the derived biomarker value being
indicative of a ratio of concentrations of the at least one pair of
immune system biomarkers; and (c) determining the indicator based
on the at least one derived biomarker value, wherein the pair of
biomarker values comprises at least one of: [0178] a) a first pair
of biomarker values comprising first and second biomarker values
corresponding to first and second biomarkers, wherein the first
immune system biomarker represents a polynucleotide expression
product of the PLA2G7 gene and wherein the second immune system
biomarker representing a polynucleotide expression product of the
PLAC8 gene, and [0179] b) a second pair of biomarker values
comprises third and fourth biomarker values corresponding to third
and fourth immune system biomarkers, respectively, wherein the
third immune system biomarker represents a polynucleotide
expression product of the CEACAM4 gene and wherein the fourth
immune system biomarker represents a polynucleotide expression
product of the LAMP1 gene.
[0180] Typically the indicator-determining method comprises:
determining the first pair and second pair of biomarker values and
determining a first derived biomarker value calculated using the
first pair of biomarker values and a second derived biomarker value
calculated using the second pair of biomarker values; and
determining the indicator based on a combination of the first and
second derived biomarker values.
[0181] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression of inSIRS in
a subject, the method comprising: exposing the subject to a
treatment regimen for treating inSIRS based on an indicator
obtained from an indicator-determining method, wherein the
indicator is indicative of the presence of inSIRS in the subject,
the indicator-determining method comprising: (a) determining at
least one pair of biomarker values, each biomarker value being a
value measured or derived for at least one corresponding immune
system biomarker of the biological subject and being at least
partially indicative of a concentration of the immune system
biomarker in a sample taken from the subject, (b) determining at
least one derived biomarker value using the at least one pair of
biomarker values, the derived biomarker value being indicative of a
ratio of concentrations of the pair of immune system biomarkers;
and (c) determining the indicator based on the at least one derived
biomarker value, wherein the at least one pair of biomarker values
comprises first and second biomarker values corresponding to first
and second immune system biomarkers, respectively, wherein the
first immune system biomarker represents a polynucleotide
expression product of a first IRS immune system biomarker gene, and
wherein the second immune system biomarker represents a
polynucleotide expression product of a second IRS immune system
biomarker gene, wherein the first IRS immune system biomarker gene
is selected from group A IRS immune system biomarker genes and
wherein the second IRS immune system biomarker gene is selected
from group B IRS immune system biomarker genes.
[0182] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression of ipSIRS in
a subject, the method comprising: exposing the subject to a
treatment regimen for treating ipSIRS based on an indicator
obtained from an indicator-determining method, wherein the
indicator is indicative of the presence of ipSIRS in the subject,
the indicator-determining method comprising: (a) determining at
least one pair of biomarker values, each biomarker value being a
value measured or derived for at least one corresponding immune
system biomarker of the biological subject and being at least
partially indicative of a concentration of the immune system
biomarker in a sample taken from the subject, (b) determining at
least one derived biomarker value using the at least one pair of
biomarker values, the derived biomarker value being indicative of a
ratio of concentrations of the at least one pair of immune system
biomarkers; and (c) determining the indicator based on the at least
one derived biomarker value, wherein the at least one pair of
biomarker values comprises first and second biomarker values
corresponding to first and second immune system biomarkers,
respectively, wherein the first immune system biomarker represents
a polynucleotide expression product of a first IRS immune system
biomarker gene, and wherein the second immune system biomarker
represents a polynucleotide expression product of a second IRS
immune system biomarker gene, wherein the first IRS immune system
biomarker gene is selected from group C IRS immune system biomarker
genes and wherein the second IRS immune system biomarker gene is
selected from group D IRS immune system biomarker genes.
[0183] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
inSIRS and ipSIRS, the method comprising: exposing the subject to a
treatment regimen for treating the at least one condition based on
an indicator obtained from an indicator-determining method, wherein
the indicator is indicative of the presence of the at least one
condition in the subject, the indicator-determining method
comprising: (a) determining at least one pair of biomarker values,
each biomarker value being a value measured or derived for at least
one corresponding immune system biomarker of the biological subject
and being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject, (b)
determining at least one derived biomarker value using the at least
one pair of biomarker values, the derived biomarker value being
indicative of a ratio of concentrations of the at least one pair of
immune system biomarkers; and (c) determining the indicator based
on the at least one derived biomarker value, wherein the at least
one pair of biomarker values comprises first and second biomarker
values corresponding to of first and second immune system
biomarkers, respectively, wherein the first immune system biomarker
represents a polynucleotide expression product of a first IRS
immune system biomarker gene, and wherein the second immune system
biomarker represents a polynucleotide expression product of a
second IRS immune system biomarker gene, wherein the first IRS
immune system biomarker gene is selected from group E IRS immune
system biomarker genes and wherein the second IRS immune system
biomarker gene is selected from group F IRS immune system biomarker
genes.
[0184] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
inSIRS and ipSIRS, the method comprising: exposing the subject to a
treatment regimen for treating the at least one condition based on
an indicator obtained from an indicator-determining method, wherein
the indicator is indicative of the presence of the at least one
condition in the subject, the indicator-determining method
comprising: (a) determining at least two pairs of biomarker values,
each biomarker value being a value measured or derived for at least
one corresponding immune system biomarker of the biological subject
and being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject, (b)
determining at least two derived biomarker values using the at
least two pairs of biomarker values, the derived biomarker value
being indicative of a ratio of concentrations of each pair of
immune system biomarkers; and (c) determining the indicator based
on the at least two derived biomarker values, wherein the at least
one pair of biomarker values comprises a first pair of biomarker
values comprising first and second biomarker values corresponding
to first and second immune system biomarkers, respectively, wherein
the first immune system biomarker represents a polynucleotide
expression product of a first IRS immune system biomarker gene and
wherein the second immune system biomarker represents a
polynucleotide expression product of a second IRS immune system
biomarker gene, and a second pair of biomarker values comprising
third and fourth biomarker values corresponding to third and fourth
immune system biomarkers, respectively, wherein the third immune
system biomarker represents a polynucleotide expression product of
a third IRS immune system biomarker gene and wherein the fourth
immune system biomarker represents a polynucleotide expression
product of a fourth IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group G IRS
immune system biomarker genes, wherein the second IRS immune system
biomarker gene is selected from group H IRS immune system biomarker
genes, wherein the third IRS immune system biomarker gene is
selected from group I IRS immune system biomarker genes, and
wherein the fourth IRS immune system biomarker gene is selected
from group J IRS immune system biomarker genes.
[0185] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
mild sepsis and severe sepsis, the method comprising: exposing the
subject to a treatment regimen for treating the at least one
condition based on an indicator obtained from an
indicator-determining method, wherein the indicator is indicative
of the presence of the at least one condition in the subject, the
indicator-determining method comprising: (a) determining at least
one pair of biomarker values, each biomarker value being a value
measured or derived for at least one corresponding immune system
biomarker of the biological subject and being at least partially
indicative of a concentration of the immune system biomarker in a
sample taken from the subject, (b) determining at least one derived
biomarker value using the at least one pair of biomarker values,
the derived biomarker value being indicative of a ratio of
concentrations of the at least one pair of immune system
biomarkers; and (c) determining the indicator based on the at least
one derived biomarker value, wherein the at least one pair of
biomarker values comprises first and second biomarker values
corresponding to first and second immune system biomarkers,
respectively, wherein the first immune system biomarker represents
a polynucleotide expression product of a first IRS immune system
biomarker gene, and wherein the second immune system biomarker
represents a polynucleotide expression product of a second IRS
immune system biomarker gene, wherein the first IRS immune system
biomarker gene is selected from group K IRS immune system biomarker
genes and wherein the second IRS immune system biomarker gene is
selected from group L IRS immune system biomarker genes.
[0186] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
mild sepsis and septic shock, the method comprising: exposing the
subject to a treatment regimen for treating the at least one
condition based on an indicator obtained from an
indicator-determining method, wherein the indicator is indicative
of the presence of the at least one condition in the subject, the
indicator-determining method comprising: (a) determining at least
one pair of biomarker values, each biomarker value being a value
measured or derived for at least one corresponding immune system
biomarker of the biological subject and being at least partially
indicative of a concentration of the immune system biomarker in a
sample taken from the subject, (b) determining at least one derived
biomarker value using the at least one pair of biomarker values,
the derived biomarker value being indicative of a ratio of
concentrations of the at least one pair of immune system
biomarkers; and (c) determining the indicator based on the at least
one derived biomarker value, wherein the at least one pair of
biomarker values comprises first and second biomarker values
corresponding to first and second immune system biomarkers,
respectively, wherein the first immune system biomarker represents
a polynucleotide expression product of a first IRS immune system
biomarker gene, and wherein the second immune system biomarker
represents a polynucleotide expression product of a second IRS
immune system biomarker gene, wherein the first IRS immune system
biomarker gene is selected from group M IRS immune system biomarker
genes and wherein the second IRS immune system biomarker gene is
selected from group N IRS immune system biomarker genes.
[0187] In another broad form the present invention seeks to provide
a method for inhibiting the development or progression in a subject
of at least one condition selected from the group consisting of
severe sepsis and septic shock, the method comprising: exposing the
subject to a treatment regimen for treating the at least one
condition based on an indicator obtained from an
indicator-determining method, wherein the indicator is indicative
of the presence of the at least one condition in the subject, the
indicator-determining method comprising: (a) determining at least
one pair of biomarker values, each biomarker value being a value
measured or derived for at least one corresponding immune system
biomarker of the biological subject and being at least partially
indicative of a concentration of the immune system biomarker in a
sample taken from the subject, (b) determining at least one derived
biomarker value using the at least one pair of biomarker values,
the derived biomarker value being indicative of a ratio of
concentrations of the at least one pair of immune system
biomarkers; and (c) determining the indicator based on the at least
one derived biomarker value, wherein the at least one pair of
biomarker values comprises first and second biomarker values
corresponding to first and second immune system biomarkers,
respectively, wherein the first immune system biomarker represents
a polynucleotide expression product of a first IRS immune system
biomarker gene, and wherein the second immune system biomarker
represents a polynucleotide expression product of a second IRS
immune system biomarker gene, wherein the first IRS immune system
biomarker gene is selected from group O IRS immune system biomarker
genes and wherein the second IRS immune system biomarker gene is
selected from group P IRS immune system biomarker genes.
[0188] In some embodiments, the method comprises taking the sample
from the subject and obtaining the indicator according to the
indicator-determining method.
[0189] In some embodiments, the method comprises: sending the
sample taken from the subject to a laboratory at which the
indicator is determined.
[0190] Typically, the sample comprises cells obtained from the
subject or a nucleic acid sample thereof.
[0191] In another broad form the present invention seeks to provide
a method for differentiating between inSIRS and ipSIRS in a
biological subject, the method including: [0192] a) obtaining a
sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0193] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being selected from the group consisting of:
[0194] i) a first pair of biomarker values indicative of a
concentration of polynucleotide expression products of the PLA2G7
gene and PLAC8 gene; [0195] ii) a second pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the CEACAM4 gene and LAMP1 gene; [0196] c) determining an
indicator indicative of a ratio of concentrations of the
polynucleotide expression products using the pair of biomarker
values; and, [0197] d) comparing the indicator to first and second
indicator references, the first and second indicator references
being indicative of inSIRS and ipSIRS, respectively; and, [0198] e)
determining a likelihood of the subject having inSIRS or ipSIRS in
accordance with the results of the comparison.
[0199] In another broad form the present invention seeks to provide
a method for differentiating between inSIRS and a healthy condition
in a biological subject, the method including: [0200] a) obtaining
a sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0201] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group A IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group B IRS
immune system biomarker genes; [0202] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0203]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of inSIRS and healthy condition, respectively; and,
[0204] e) determining a likelihood of the subject having inSIRS or
the healthy condition in accordance with the results of the
comparison.
[0205] In another broad form the present invention seeks to provide
a method for differentiating between ipSIRS and a healthy condition
in a biological subject, the method including: [0206] a) obtaining
a sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0207] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group C IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group D IRS
immune system biomarker genes; [0208] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0209]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of ipSIRS and healthy condition, respectively; and,
[0210] e) determining a likelihood of the subject having ipSIRS or
the healthy condition in accordance with the results of the
comparison.
[0211] In another broad form the present invention seeks to provide
a method for differentiating between inSIRS and ipSIRS in a
biological subject, the method including: [0212] a) obtaining a
sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0213] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group E IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group F IRS
immune system biomarker genes; [0214] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0215]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of inSIRS and ipSIRS, respectively; and, [0216] e)
determining a likelihood of the subject having inSIRS or ipSIRS in
accordance with the results of the comparison.
[0217] In another broad form the present invention seeks to provide
a method for differentiating between inSIRS and ipSIRS in a
biological subject, the method including: [0218] a) obtaining a
sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0219] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being selected from the group consisting of:
[0220] i) a first pair of biomarker values indicative of a
concentration of polynucleotide expression products of a first IRS
immune system biomarker gene and a second IRS immune system
biomarker gene, wherein the first IRS immune system biomarker gene
is selected from group G IRS immune system biomarker genes and
wherein the second IRS immune system biomarker gene is selected
from group H IRS immune system biomarker genes; [0221] ii) a second
pair of biomarker values indicative of a concentration of
polynucleotide expression products of a third IRS immune system
biomarker gene and a fourth IRS immune system biomarker gene,
wherein the third IRS immune system biomarker gene is selected from
group I IRS immune system biomarker genes and wherein the fourth
IRS immune system biomarker gene is selected from group J IRS
immune system biomarker genes; [0222] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0223]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of inSIRS and ipSIRS, respectively; and, [0224] e)
determining a likelihood of the subject having inSIRS or ipSIRS in
accordance with the results of the comparison.
[0225] In another broad form the present invention seeks to provide
a method for differentiating between mild sepsis and severe sepsis
in a biological subject, the method including: [0226] a) obtaining
a sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0227] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group K IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group L IRS
immune system biomarker genes; [0228] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0229]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of mild sepsis and severe sepsis, respectively; and,
[0230] e) determining a likelihood of the subject having mild
sepsis or severe sepsis in accordance with the results of the
comparison.
[0231] In another broad form the present invention seeks to provide
a method for differentiating between mild sepsis and septic shock
in a biological subject, the method including: [0232] a) obtaining
a sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0233] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group M IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group N IRS
immune system biomarker genes; [0234] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0235]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of mild sepsis and septic shock, respectively; and,
[0236] e) determining a likelihood of the subject having mild
sepsis or septic shock in accordance with the results of the
comparison.
[0237] In another broad form the present invention seeks to provide
a method for differentiating between severe sepsis and septic shock
in a biological subject, the method including: [0238] a) obtaining
a sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0239] b) quantifying polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being indicative of a concentration of
polynucleotide expression products of a first IRS immune system
biomarker gene and a second IRS immune system biomarker gene,
wherein the first IRS immune system biomarker gene is selected from
group O IRS immune system biomarker genes and wherein the second
IRS immune system biomarker gene is selected from group P IRS
immune system biomarker genes; [0240] c) determining an indicator
indicative of a ratio of concentrations of the polynucleotide
expression products using the pair of biomarker values; and, [0241]
d) comparing the indicator to first and second indicator
references, the first and second indicator references being
indicative of severe sepsis and septic shock, respectively; and,
[0242] e) determining a likelihood of the subject having severe
sepsis or septic shock in accordance with the results of the
comparison.
[0243] Typically the method includes determining: [0244] a) a first
derived biomarker value indicative of a ratio of concentrations of
the polynucleotide expression products using the first pair of
biomarker values; [0245] b) a second derived biomarker value
indicative of a ratio of concentrations of the polynucleotide
expression products using the first pair of biomarker values; and,
[0246] c) determining the indicator by combining the first and
second derived biomarker values.
[0247] Typically the first and second indicator references are
distributions of indicators determined for first and second groups
of a reference population, the first and second group consisting of
individuals diagnosed with inSIRS and ipSIRS respectively.
[0248] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0249] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0250] b) amplifying at least some
polynucleotide expression products in the sample; [0251] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: [0252] i) a first pair of polynucleotide expression
products of the PLA2G7 gene and PLAC8 gene; [0253] ii) a second
pair of polynucleotide expression products of the CEACAM4 gene and
LAMP1 gene; [0254] d) determining the indicator by determining a
difference between the amplification amounts; and, [0255] e) using
the indicator to assess the likelihood of a biological subject
having a medical condition.
[0256] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0257] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0258] b) amplifying at least some
polynucleotide expression products in the sample; [0259] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group A IRS
immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group B IRS immune system
biomarker genes; [0260] d) determining the indicator by determining
a difference between the amplification amounts; and, [0261] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0262] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0263] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0264] b) amplifying at least some
polynucleotide expression products in the sample; [0265] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group C IRS
immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group D IRS immune system
biomarker genes; [0266] d) determining the indicator by determining
a difference between the amplification amounts; and, [0267] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0268] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0269] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0270] b) amplifying at least some
polynucleotide expression products in the sample; [0271] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group E IRS
immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group F IRS immune system
biomarker genes; [0272] d) determining the indicator by determining
a difference between the amplification amounts; and, [0273] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0274] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0275] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0276] b) amplifying at least some
polynucleotide expression products in the sample; [0277] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: [0278] i) a first pair of polynucleotide expression
products of a first IRS immune system biomarker gene and a second
IRS immune system biomarker gene, wherein the first IRS immune
system biomarker gene is selected from group G IRS immune system
biomarker genes and wherein the second IRS immune system biomarker
gene is selected from group H IRS immune system biomarker genes;
[0279] ii) a second pair of polynucleotide expression products of a
third IRS immune system biomarker gene and a fourth IRS immune
system biomarker gene, wherein the third IRS immune system
biomarker gene is selected from group I IRS immune system biomarker
genes and wherein the fourth IRS immune system biomarker gene is
selected from group J IRS immune system biomarker genes; [0280] d)
determining the indicator by determining a difference between the
amplification amounts; and, [0281] e) using the indicator to assess
the likelihood of a biological subject having a medical
condition.
[0282] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0283] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0284] b) amplifying at least some
polynucleotide expression products in the sample; [0285] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group K IRS
immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group L IRS immune system
biomarker genes; [0286] d) determining the indicator by determining
a difference between the amplification amounts; and, [0287] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0288] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0289] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0290] b) amplifying at least some
polynucleotide expression products in the sample; [0291] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
second IRS immune system biomarker gene is selected from group M
IRS immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group N IRS immune system
biomarker genes; [0292] d) determining the indicator by determining
a difference between the amplification amounts; and, [0293] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0294] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing the
likelihood of a biological subject having at least one medical
condition, the method including: [0295] a) obtaining a sample taken
from a biological subject, the sample including polynucleotide
expression products; [0296] b) amplifying at least some
polynucleotide expression products in the sample; [0297] c)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of each of a pair
of polynucleotide expression products selected from the group
consisting of: a polynucleotide expression product of a first IRS
immune system biomarker gene and a polynucleotide expression
product of a second IRS immune system biomarker gene, wherein the
first IRS immune system biomarker gene is selected from group O IRS
immune system biomarker genes and wherein the second IRS immune
system biomarker gene is selected from group P IRS immune system
biomarker genes; [0298] d) determining the indicator by determining
a difference between the amplification amounts; and, [0299] e)
using the indicator to assess the likelihood of a biological
subject having a medical condition.
[0300] Typically the method includes determining: [0301] a) a first
derived biomarker value by determining a difference between the
amplification amounts of the first pair of polynucleotide
expression products; [0302] b) a second derived biomarker value by
determining a difference between the amplification amounts of the
second pair of polynucleotide expression products; [0303] c)
determining the indicator by adding the first and second derived
biomarker values.
[0304] Typically the method includes determining: [0305] a)
comparing the indicator to first and second indicator references,
wherein the first and second indicator references are distributions
of indicators determined for first and second groups of a reference
population, one of the first and second groups consisting of
individuals diagnosed with the medical condition; and, [0306] b)
determining a likelihood of the subject having the medical
condition in accordance with the results of the comparison.
[0307] Typically the amplification amount is at least one of:
[0308] a) a cycle time; [0309] b) a number of cycles; [0310] c) a
cycle threshold; [0311] d) an amplification time; and, [0312] e)
relative to an amplification amount of another amplified
product.
[0313] In another broad form the present invention seeks to provide
a method for use in assessing the likelihood of a biological
subject having a medical condition, the method including, in one or
more processing devices: [0314] a) determining a pair of biomarker
values, the pair of biomarker values being selected from the group
consisting of: [0315] i) a first pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the PLA2G7 gene and PLAC8 gene; [0316] ii) a second pair of
biomarker values indicative of a concentration of polynucleotide
expression products of the CEACAM4 gene and LAMP1 gene; [0317] b)
determining an indicator indicative of a ratio of the
concentrations of the polynucleotide expression products using the
pair of biomarker values; [0318] c) retrieving previously
determined first and second indicator references from a database,
the first and second indicator references being determined based on
indicators determined from first and second groups of a reference
population, one of the groups consisting of individuals diagnosed
with the medical condition; [0319] d) comparing the indicator to
the first and second indicator references; [0320] e) using the
results of the comparison to determine a probability indicative of
the subject having the medical condition; and, [0321] f) generating
a representation of the probability, the representation being
displayed to a user to allow the user to assess the likelihood of a
biological subject having at least one medical condition.
[0322] Typically the method includes determining: [0323] a) a first
derived biomarker value indicative of a ratio of concentrations of
the polynucleotide expression products using the first pair of
biomarker values; [0324] b) a second derived biomarker value
indicative of a ratio of concentrations of the polynucleotide
expression products using the first pair of biomarker values; and,
[0325] c) determining the indicator by combining the first and
second derived biomarker values.
[0326] In another broad form the present invention seeks to provide
apparatus for determining an indicator used in determining the
likelihood of a biological subject having at least one medical
condition, the apparatus including: [0327] a) a sampling device
that obtains a sample taken from a biological subject, the sample
including polynucleotide expression products; [0328] b) a measuring
device that quantifies polynucleotide expression products within
the sample to determine a pair of biomarker values, the pair of
biomarker values being selected from the group consisting of:
[0329] i) a first pair of biomarker values indicative of a
concentration of polynucleotide expression products of the PLA2G7
gene and PLAC8 gene; [0330] ii) a second pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the CEACAM4 gene and LAMP1 gene; [0331] c) at least one
processing device that: [0332] i) receives an indication of the
pair of biomarker values from the measuring device; [0333] ii)
determines an indicator using a ratio of the concentration of the
first and second polynucleotide expression products using the
biomarker values; and, iii) compares the indicator to at least one
indicator reference; and, [0334] iv) determines a likelihood of the
subject having the at least one medical condition using the results
of the comparison; and, [0335] v) generates a representation of the
indicator and the likelihood for display to a user.
[0336] In another broad form the present invention seeks to provide
a method for differentiating between inSIRS and ipSIRS in a
biological subject, the method including: [0337] a) obtaining a
sample taken from a biological subject showing a clinical sign of
SIRS, the sample including polynucleotide expression products;
[0338] b) in a measuring device: [0339] i) amplifying at least some
polynucleotide expression products in the sample; [0340] ii)
determining an amplification amount representing a degree of
amplification required to obtain a defined level of polynucleotide
expression products including: [0341] (1) amplification amounts for
a first pair of polynucleotide expression products of the PLA2G7
gene and PLAC8 gene; [0342] (2) amplification amounts for a second
pair of polynucleotide expression products of the CEACAM4 gene and
LAMP1 gene; [0343] c) in a processing system: [0344] i) retrieving
the amplification amounts; [0345] ii) determining an indicator by:
[0346] (1) determining a first derived biomarker value indicative
of a ratio of concentrations of the first pair of polynucleotide
expression products by determining a difference between the
amplification amounts for the first pair; [0347] (2) determining a
second derived biomarker value indicative of a ratio of
concentrations of the second pair of polynucleotide expression
products by determining a difference between the amplification
amounts for the second pair; [0348] (3) determining the indicator
by adding the first and second derived biomarker values; [0349]
iii) retrieving previously determined first and second indicator
references from a database, wherein the first and second indicator
references are distributions of indicators determined for first and
second groups of a reference population, the first and second group
consisting of individuals diagnosed with inSIRS and ipSIRS
respectively; [0350] iv) comparing the indicator to the first and
second indicator references; [0351] v) using the results of the
comparison to determine a probability of the subject being
classified within the first or second group; [0352] vi) generating
a representation at least partially indicative of the indicator and
the probability; and, [0353] vii) providing the representation to a
user to allow the user to assess the likelihood of a biological
subject having at least one medical condition.
[0354] In another broad form the present invention seeks to provide
a method for determining an indicator used in assessing a
likelihood of a biological subject having a presence, absence,
degree or prognosis of at least one medical condition, the method
including: [0355] a) determining a plurality of biomarker values,
each biomarker value being indicative of a value measured or
derived for at least one corresponding immune system biomarker of
the biological subject and being at least partially indicative of a
concentration of the immune system biomarker in a sample taken from
the subject; [0356] b) determining the indicator using a
combination of the plurality of biomarker values, wherein: [0357]
i) at least two biomarkers have a mutual correlation in respect of
the at least one condition that lies within a mutual correlation
range, the mutual correlation range being between .+-.0.9; and,
[0358] ii) the indicator has a performance value greater than or
equal to a performance threshold representing the ability of the
indicator to diagnose the presence, absence, degree or prognosis of
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3.
[0359] Typically the method includes: [0360] c) determining a
plurality of measured biomarker values, each measured biomarker
value being a measured value of a corresponding biomarker of the
biological subject; and, [0361] d) determining the indicator by
applying a function to at least one of the measured biomarker
values to determine at least one derived biomarker value, the at
least one derived biomarker value being indicative of a value of a
corresponding derived biomarker.
[0362] Typically the function includes at least one of: [0363] a)
multiplying two biomarker values; [0364] b) dividing two biomarker
values; [0365] c) adding two biomarker values; [0366] d)
subtracting two biomarker values; [0367] e) a ratio of two
biomarker values; [0368] f) a weighted sum of at least two
biomarker values; [0369] g) a log sum of at least two biomarker
values; and, [0370] h) a sigmoidal function of at least two
biomarker values.
[0371] Typically the method includes determining at least one
derived biomarker value corresponding to a ratio of two measured
biomarker values.
[0372] Typically the method includes combining at least two
biomarker values to determine an indicator value representing the
indicator.
[0373] Typically the method includes combining at least two
biomarker values using a combining function, the combining function
being at least one of: [0374] a) an additive model; [0375] b) a
linear model; [0376] c) a support vector machine; [0377] d) a
neural network model; [0378] e) a random forest model; [0379] f) a
regression model; [0380] g) a genetic algorithm; [0381] h) an
annealing algorithm; [0382] i) a weighted sum; [0383] j) a nearest
neighbor model; and, [0384] k) a probabilistic model.
[0385] Typically at least one of the at least two biomarkers is a
derived biomarker.
[0386] Typically the method includes: [0387] a) determining a first
derived biomarker value, the first derived biomarker value being
indicative of a ratio of concentrations of the first and second
immune system biomarkers; [0388] b) determining a second derived
biomarker value, the second derived biomarker value being
indicative of a ratio of concentrations of the third and fourth
measured immune system biomarkers; and, [0389] c) adding the first
and second derived biomarker values to generate an indicator
value.
[0390] Typically the method is performed at least in part using an
electronic processing device.
[0391] Typically the method includes, in the electronic processing
device: [0392] a) receiving a plurality of measured biomarker
values, each measured biomarker value being a measured value of a
corresponding immune system biomarker; [0393] b) applying a
function to at least one of the measured biomarker values to
determine at least one derived biomarker value, the at least one
derived biomarker value being indicative of a value of a
corresponding derived biomarker; and, [0394] c) combining at least
one derived biomarker value and at least one other biomarker value
to determine the indicator.
[0395] Typically the mutual correlation range is at least one of:
[0396] a) .+-.0.8; [0397] b) .+-.0.7; [0398] c) .+-.0.6; [0399] d)
.+-.0.5; [0400] e) .+-.0.4; [0401] f) .+-.0.3; [0402] g) .+-.0.2;
and, [0403] h) .+-.0.1.
[0404] Typically each biomarker has a condition correlation with
the presence, absence, degree or prognosis of the at least one
condition that lies outside a condition correlation range, the
condition correlation range being between .+-.0.3.
[0405] Typically the condition correlation range is at least one
of: [0406] a) .+-.0.9; [0407] b) .+-.0.8; [0408] c) .+-.0.7; [0409]
d) .+-.0.6; [0410] e) .+-.0.5; and, [0411] f) .+-.0.4.
[0412] Typically the performance threshold is indicative of an
explained variance of at least one of: [0413] a) 0.4; [0414] b)
0.5; [0415] c) 0.6; [0416] d) 0.7; [0417] e) 0.8; and, [0418] f)
0.9.
[0419] Typically the biomarker value is indicative of a level or
abundance of a molecule selected from one or more of a nucleic acid
molecule and a proteinaceous molecule.
[0420] Typically the method includes generating a representation of
the indicator.
[0421] Typically the representation includes: [0422] a) an
alphanumeric indication of the indicator; [0423] b) a graphical
indication of a comparison of the indicator to one or more
indicator references; [0424] c) an alphanumeric indication of a
likelihood of the subject having at least one medical
condition.
[0425] Typically the method includes: [0426] a) comparing the
indicator to an indicator reference; and, [0427] b) determining a
likelihood in accordance with results of the comparison.
[0428] Typically the indicator reference is based on at least one
of: [0429] a) an indicator threshold range; [0430] b) an indicator
threshold; and, [0431] c) an indicator distribution.
[0432] Typically the indicator reference is derived from indicators
determined for a number of individuals in a reference
population.
[0433] Typically the indicator reference is based on a distribution
of indicators determined for a group of a reference population, the
group consisting of individuals diagnosed with the medical
condition.
[0434] Typically the reference population includes: [0435] a) a
plurality of individuals of different sexes; [0436] b) a plurality
of individuals of different ethnicities; [0437] c) a plurality of
healthy individuals; [0438] d) a plurality of individuals suffering
from at least one diagnosed medical condition; [0439] e) a
plurality of individuals showing clinical signs of at least one
medical condition; and, [0440] f) first and second groups of
individuals, each group of individuals suffering from a respective
diagnosed medical condition.
[0441] Typically the indicator is for use in determining the
likelihood that a biological subject has at least one medical
condition, and wherein the reference population includes: [0442] a)
individuals presenting with clinical signs of the at least one
medical condition; [0443] b) individuals diagnosed with the at
least one medical condition; and, [0444] c) healthy
individuals.
[0445] Typically the indicator reference is retrieved from a
database.
[0446] Typically the likelihood is based on a probability generated
using the results of the comparison.
[0447] Typically the indicator is for determining a likelihood of
the subject having a first or second condition, and wherein the
method includes: [0448] a) comparing the indicator to first and
second indicator references, the first and second indicator
references being indicative of first and second conditions; and,
[0449] b) determining the likelihood in accordance with the results
of the comparison.
[0450] Typically the method includes: [0451] a) determining first
and second indicator probabilities using the results of the
comparisons; and, [0452] b) combining the first and second
indicator probabilities to determine a condition probability
indicative of the likelihood.
[0453] Typically the first and second indicator references are
distributions of indicators determined for first and second groups
of a reference population, the first and second group consisting of
individuals diagnosed with the first or second condition
respectively.
[0454] Typically the method includes: [0455] a) obtaining a sample
taken from the biological subject, the sample including
polynucleotide expression products; [0456] b) quantifying at least
some of the polynucleotide expression products within the sample to
determine at least a pair of biomarker values; [0457] c)
determining the indicator at least in part using the pair of
biomarker values;
[0458] Typically the method includes, determining the indicator at
least in part using a ratio of concentrations of the polynucleotide
expression products.
[0459] Typically the method includes: [0460] a) quantifying
polynucleotide expression products by: [0461] b) amplifying at
least some polynucleotide expression products in the sample; and,
[0462] c) determining an amplification amount representing a degree
of amplification required to obtain a defined level of each of a
pair of polynucleotide expression products; and, [0463] d)
determining the indicator by determining a difference between the
amplification amounts.
[0464] Typically the amplification amount is at least one of:
[0465] a) a cycle time; [0466] b) a number of cycles; [0467] c) a
cycle threshold; [0468] d) an amplification time; and, [0469] e)
relative to an amplification amount of another amplified
product.
[0470] Typically the method includes determining: [0471] a) a first
derived biomarker value by determining a difference between the
amplification amounts of a first pair of polynucleotide expression
products; [0472] b) a second derived biomarker value by determining
a difference between the amplification amounts of a second pair of
polynucleotide expression products; [0473] c) determining the
indicator by adding the first and second derived biomarker
values.
[0474] Typically the immune system biomarker is an IRS biomarker of
an immune system of the biological subject that is altered, or
whose level of expression is altered, as part of an inflammatory
response to damage or pathogenic insult.
[0475] Typically the indicator is for determining a likelihood of
the subject having at least one of inSIRS and ipSIRS, and wherein
the method includes: [0476] a) determining a first pair of
biomarker values indicative of a concentration of polynucleotide
expression products of the PLA2G7 gene and PLAC8 gene; [0477] b)
determining a second pair of biomarker values indicative of a
concentration of polynucleotide expression products of the CEACAM4
gene and LAMP1 gene; and, [0478] c) determining the indicator using
the first and second pairs of biomarker values.
[0479] Typically the indicator is for determining a likelihood of
the subject having inSIRS or ipSIRS, and wherein the method
includes: [0480] a) determining a first pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the PLA2G7 gene and PLAC8 gene; [0481] b) determining a second
pair of biomarker values indicative of a concentration of
polynucleotide expression products of the CEACAM4 gene and LAMP1
gene; and, [0482] c) determining the indicator using the first and
second pairs of biomarker values.
[0483] Typically the indicator is for determining a likelihood of
the subject having inSIRS or a healthy condition, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0484] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group A IRS immune system biomarker genes; and [0485]
b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group B
IRS immune system biomarker genes.
[0486] Typically the indicator is for determining a likelihood of
the subject having ipSIRS or a healthy condition, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0487] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group C IRS immune system biomarker genes; and,
[0488] b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group D
IRS immune system biomarker genes.
[0489] Typically the indicator is for determining a likelihood of
the subject having inSIRS or ipSIRS, and wherein biomarker values
are determined from at least one IRS immune system biomarker in
each of first and second IRS immune system biomarker groups,
wherein: [0490] a) the first IRS immune system biomarker group
consists of polynucleotide and/or polypeptide expression products
from group E IRS immune system biomarker genes; and, [0491] b) the
second IRS immune system biomarker group consists of polynucleotide
and/or polypeptide expression products from group F IRS immune
system biomarker genes.
[0492] Typically the indicator is for determining a likelihood of
the subject having inSIRS or ipSIRS, and wherein biomarker values
are determined from at least one IRS immune system biomarker in
each of first, second, third and fourth IRS immune system biomarker
groups, wherein: [0493] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group G IRS immune system biomarker genes; [0494] b)
the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group H
IRS immune system biomarker genes; [0495] c) the third IRS immune
system biomarker group consists of polynucleotide and/or
polypeptide expression products from group I IRS immune system
biomarker genes; and, [0496] d) the fourth IRS immune system
biomarker group consists of polynucleotide and/or polypeptide
expression products from group J IRS immune system biomarker
genes.
[0497] Typically the first IRS immune system biomarker is a PLA2G7
expression product, the second IRS immune system biomarker is a
PLAC8 expression product, the third IRS immune system biomarker is
a CEACAM4 expression product and the fourth IRS immune system
biomarker is a LAMP1 expression product.
[0498] Typically the indicator is for determining a likelihood of
the subject having mild sepsis or severe sepsis, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0499] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group K IRS immune system biomarker genes; and,
[0500] b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group L
IRS immune system biomarker genes.
[0501] Typically the indicator is for determining a likelihood of
the subject having mild sepsis or septic shock, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0502] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group M IRS immune system biomarker genes; and,
[0503] b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group N
IRS immune system biomarker genes.
[0504] Typically the indicator is for determining a likelihood of
the subject having severe sepsis or septic shock, and wherein
biomarker values are determined from at least one IRS immune system
biomarker in each of first and second IRS immune system biomarker
groups, wherein: [0505] a) the first IRS immune system biomarker
group consists of polynucleotide and/or polypeptide expression
products from group O IRS immune system biomarker genes; and,
[0506] b) the second IRS immune system biomarker group consists of
polynucleotide and/or polypeptide expression products from group P
IRS immune system biomarker genes.
[0507] In another broad form the present invention seeks to provide
apparatus for determining an indicator used in assessing a
likelihood of a biological subject having a presence, absence,
degree or prognosis of at least one medical condition, the
apparatus including a processing device that: [0508] a) determines
a plurality of biomarker values, each biomarker value being
indicative of a value measured or derived for at least one
corresponding immune system biomarker of the biological subject and
being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject; [0509]
b) determines the indicator using a combination of the plurality of
biomarker values, wherein: [0510] i) at least two biomarkers have a
mutual correlation in respect of the at least one condition that
lies within a mutual correlation range, the mutual correlation
range being between .+-.0.9; and, [0511] ii) the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence, degree or prognosis of the at least one condition, the
performance threshold being indicative of an explained variance of
at least 0.3.
[0512] In one broad form the present invention seeks to provide a
method for determining an indicator for use in diagnosing the
presence, absence, degree or prognosis of at least one condition in
a biological subject, the method including: [0513] a) determining a
plurality of biomarker values, each biomarker value being
indicative of a value measured or derived for at least one
corresponding biomarker of the biological subject; [0514] b)
determining the indicator using a combination of the plurality of
biomarker values, the at least one indicator being at least
partially indicative of the presence, absence, degree or prognosis
of the at least one condition, wherein: [0515] i) at least two
markers have a mutual correlation in respect of the at least one
condition that lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; and, [0516] ii) the
indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence, degree or prognosis of the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3.
[0517] Typically the method includes: [0518] a) determining a
plurality of measured biomarker values, each measured biomarker
value being a measured value of a corresponding biomarker of the
biological subject; and, [0519] b) applying a function to at least
one of the measured biomarker values to determine at least one
derived biomarker value, the at least one derived biomarker value
being indicative of a value of a corresponding derived
biomarker.
[0520] Typically the function includes at least one of: [0521] a)
multiplying two biomarker values; [0522] b) dividing two biomarker
values; [0523] c) adding two biomarker values; [0524] d)
subtracting two biomarker values; [0525] e) a weighted sum of at
least two biomarker values; [0526] f) a log sum of at least two
biomarker values; and, [0527] g) a sigmoidal function of at least
two biomarker values.
[0528] Typically the method includes determining at least one
derived biomarker value corresponding to a ratio of two measured
biomarker values.
[0529] Typically the method includes combining at least two
biomarker values to determine an indicator value representing the
indicator.
[0530] Typically the method includes combining at least two
biomarker values using a combining function, the combining function
being at least one of: [0531] a) an additive model; [0532] b) a
linear model; [0533] c) a support vector machine; [0534] d) a
neural network model; [0535] e) a random forest model; [0536] f) a
regression model; [0537] g) a genetic algorithm; [0538] h) an
annealing algorithm; [0539] i) a weighted sum; [0540] j) a nearest
neighbor model; and, [0541] k) a probabilistic model.
[0542] Typically at least one of the at least two biomarkers is a
derived biomarker.
[0543] Typically the method includes: [0544] a) determining a first
derived biomarker value, the first derived biomarker value being a
ratio of first and second measured biomarker values; [0545] b)
determining a second derived biomarker value, the second derived
biomarker value being a ratio of third and fourth measured
biomarker values; and, [0546] c) adding the first and second
derived biomarker values to generate an indicator value.
[0547] Typically the method includes: [0548] a) determining an
indicator value; [0549] b) comparing the indicator value to at
least one indicator value range; and, [0550] c) using a result of
the comparison in diagnosing the presence, absence, degree or
prognosis of at least one condition.
[0551] Typically the method is performed at least in part using an
electronic processing device.
[0552] Typically the method includes, in the electronic processing
device: [0553] a) receiving a plurality of measured biomarker
values, each measured biomarker value being a measured value of a
corresponding biomarker of the biological subject; [0554] b)
applying a function to at least one of the measured biomarker
values to determine at least one derived biomarker value, the at
least one derived biomarker value being indicative of a value of a
corresponding derived biomarker; and, [0555] c) combining at least
one derived biomarker value and at least one other biomarker value
to determine an indicator value.
[0556] Typically the method includes generating a representation in
accordance with the at least one indicator value.
[0557] Typically the method includes: [0558] a) comparing the
indicator value to at least one indicator value range; and, [0559]
b) displaying a result of the comparison.
[0560] Typically the mutual correlation range is at least one of:
[0561] a) .+-.0.8; [0562] b) .+-.0.7; [0563] c) .+-.0.6; [0564] d)
.+-.0.5; [0565] e) .+-.0.4; [0566] f) .+-.0.3; [0567] g) .+-.0.2;
and, [0568] h) .+-.0.1.
[0569] Typically each biomarker has a condition correlation with
the presence, absence, degree or prognosis of the at least one
condition that lies outside a condition correlation range, the
condition correlation range being between .+-.0.3.
[0570] Typically the condition correlation range is at least one
of: [0571] a) .+-.0.9; [0572] b) .+-.0.8; [0573] c) .+-.0.7; [0574]
d) .+-.0.6; [0575] e) .+-.0.5; and, [0576] f) .+-.0.4.
[0577] Typically the performance threshold is indicative of an
explained variance of at least one of: [0578] a) 0.4; [0579] b)
0.5; [0580] c) 0.6; [0581] d) 0.7; [0582] e) 0.8; and, [0583] f)
0.9.
[0584] Typically the biomarker value is indicative of a level or
abundance of a molecule or entity selected from one or more of:
[0585] a) A nucleic acid molecule; [0586] b) A proteinaceous
molecule; [0587] c) An amino acid [0588] d) A carbohydrate; [0589]
e) A lipid; [0590] f) A steroid; [0591] g) An inorganic molecule;
[0592] h) An ion; [0593] i) A drug; [0594] j) A chemical; [0595] k)
A metabolite; [0596] l) A toxin; [0597] m) A nutrient; [0598] n) A
gas; [0599] o) A cell; [0600] p) A pathogenic organism; and, [0601]
q) A non-pathogenic organism.
[0602] In another broad form the present invention seeks to provide
apparatus for determining an indicator for use in diagnosing the
presence, absence, degree or prognosis of at least one condition in
a biological subject, the apparatus including an electronic
processing device that: [0603] a) determines a plurality of
biomarker values, each biomarker value being indicative of a value
measured or derived for at least one corresponding biomarker of the
biological subject; [0604] b) determines the indicator using a
combination of the plurality of biomarker values, the at least one
indicator being at least partially indicative of the presence,
absence, degree or prognosis of the at least one condition,
wherein: [0605] i) at least two biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and, [0606] ii) the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence, degree or prognosis of the at least one condition, the
performance threshold being indicative of an explained variance of
at least 0.3.
[0607] In another broad form the present invention seeks to provide
a diagnostic signature for use in diagnosing the presence, absence,
degree or prognosis of at least one condition in a biological
subject, the diagnostic signature defining a combination of at
least two biomarker values corresponding to values of biomarkers
that can be measured for or derived from the biological subject,
wherein: [0608] a) at least two biomarkers have a mutual
correlation for the at least one condition that lies within a
mutual correlation range, the mutual correlation range being
between .+-.0.9; and, [0609] b) the combination of at least two
biomarker values has a performance value greater than or equal to a
performance threshold representing the ability of the combination
of the at least two biomarkers to diagnose the presence, absence,
degree or prognosis of the at least one condition, the performance
threshold being a variance explained of at least 0.3.
[0610] Typically the diagnostic signature defines a function to be
applied to at least one measured biomarker value to determine at
least one derived biomarker value, the at least one derived
biomarker value being indicative of a value of a corresponding
derived biomarker.
[0611] Typically the function includes at least one of: [0612] a)
multiplying two biomarker values; [0613] b) dividing two biomarker
values; [0614] c) adding two biomarker values; [0615] d)
subtracting two biomarker values; [0616] e) a weighted sum of at
least two biomarker values; [0617] f) a log sum of at least two
biomarker values; and, [0618] g) a sigmoidal function of at least
two biomarker values.
[0619] Typically the at least one derived biomarker value
corresponds to a ratio of two measured biomarker values.
[0620] Typically the diagnostic signature defines a combination of
at least two biomarker values for determining an indicator value
representing the indicator.
[0621] Typically the diagnostic signature defines a combining
function for combining at least two biomarker values, the combining
function being at least one of: [0622] a) an additive model; [0623]
b) a linear model; [0624] c) a support vector machine; [0625] d) a
neural network model; [0626] e) a random forest model; [0627] f) a
regression model; [0628] g) a genetic algorithm; [0629] h) an
annealing algorithm; and, [0630] i) a weighted sum.
[0631] Typically at least one of the at least two biomarkers is a
derived biomarker.
[0632] Typically the diagnostic signature defines: [0633] a) a
first derived biomarker value, the first derived biomarker value
being a ratio of first and second measured biomarker values; [0634]
b) a second derived biomarker value, the second derived biomarker
value being a ratio of third and fourth measured biomarker values;
and, [0635] c) a combination of the first and second derived
biomarker values to generate an indicator value.
[0636] Typically the diagnostic signature defines at least one
indicator value range and wherein comparison of at least one
indicator value to the at least one indicator value range is used
in diagnosing the presence, absence, degree or prognosis of at
least one condition.
[0637] Typically the mutual correlation range is at least one of:
[0638] a) .+-.0.8; [0639] b) .+-.0.7; [0640] c) .+-.0.6; [0641] d)
.+-.0.5; [0642] e) .+-.0.4; [0643] f) .+-.0.3; [0644] g) .+-.0.2;
and, [0645] h) .+-.0.1.
[0646] Typically each biomarker has a condition correlation with
the presence, absence, degree or prognosis of the at least one
condition that lies outside a condition correlation range, the
condition correlation range being between .+-.0.3.
[0647] Typically the condition correlation range is at least one
of: [0648] a) .+-.0.9; [0649] b) .+-.0.8; [0650] c) .+-.0.7; [0651]
d) .+-.0.6; [0652] e) .+-.0.5; and, [0653] f) .+-.0.4.
[0654] Typically the performance threshold is indicative of an
explained variance of at least one of: [0655] a) 0.4; [0656] b)
0.5; [0657] c) 0.6; [0658] d) 0.7; [0659] e) 0.8; and, [0660] f)
0.9.
[0661] Typically the biomarker value is indicative of a level or
abundance of a molecule or entity selected from one or more of:
[0662] a) A nucleic acid molecule; [0663] b) A proteinaceous
molecule; [0664] c) An amino acid [0665] d) A carbohydrate; [0666]
e) A lipid; [0667] f) A steroid; [0668] g) An inorganic molecule;
[0669] h) An ion; [0670] i) A drug; [0671] j) A chemical; [0672] k)
A metabolite; [0673] l) A toxin; [0674] m) A nutrient; [0675] n) A
gas; [0676] o) A cell; [0677] p) A pathogenic organism; and, [0678]
q) A non-pathogenic organism.
[0679] In another broad form the present invention seeks to provide
a method of identifying biomarkers for use in a diagnostic
signature, the diagnostic signature being for use in diagnosing the
presence, absence, degree or prognosis of at least one condition in
a biological subject, the method including: [0680] a) for a number
of candidate biomarkers, ranking the candidate biomarkers in
accordance with the ability of each biomarker to distinguish
between the presence, absence, degree or prognosis of at least one
condition in a biological subject; [0681] b) selecting at least two
candidate biomarkers in accordance with the ranking, the at least
two biomarkers having a mutual correlation for the at least one
condition that lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; [0682] c) determining a
performance value of a combination of the at least two candidate
biomarkers; and, [0683] d) defining a diagnostic signature in
accordance with the combination of the at least two biomarkers if
the performance value is greater than or equal to a performance
threshold representing the ability of the indicator to diagnose the
presence, absence, degree or prognosis of the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3.
[0684] Typically the method includes determining a combination of
at least two candidate biomarkers using a combining function, the
combining function being at least one of: [0685] a) an additive
model; [0686] b) a linear model; [0687] c) a support vector
machine; [0688] d) a neural network model; [0689] e) a random
forest model; [0690] f) a regression model; [0691] g) a genetic
algorithm; [0692] h) an annealing algorithm; and, [0693] i) a
weighted sum.
[0694] Typically the method includes: [0695] a) selecting a next
combining function; [0696] b) determining if a performance value of
a combination of the at least two candidate biomarkers determined
by the next combining function is greater than or equal to a
performance threshold; and, [0697] c) if the performance value is
not greater than or equal to a performance threshold, repeating
steps a) and b) for successive combining functions.
[0698] Typically the method includes: [0699] a) selecting two
candidate biomarkers; [0700] b) determining if a performance value
of a combination of the two candidate biomarkers is greater than or
equal to a performance threshold; and, [0701] c) if the performance
value is not greater than or equal to a performance threshold:
[0702] i) combining the selected candidate biomarkers with at least
one additional candidate biomarker; and, [0703] ii) repeating steps
a) and b) with at least one additional candidate biomarker.
[0704] Typically the method includes combining a number of
candidate biomarkers up to a limit.
[0705] Typically the method includes: [0706] a) selecting a highest
ranked candidate biomarker; [0707] b) selecting a next highest
ranked candidate biomarker; [0708] c) for the selected candidate
markers, determining if the mutual correlation for the candidate
biomarkers within the mutual correlation range; and, [0709] d) if
not, repeating steps b) and c) until two candidate biomarkers are
selected having a mutual correlation within the mutual correlation
range.
[0710] Typically the method includes: [0711] a) defining at least
two groups of candidate biomarkers, candidate biomarkers in
different groups having a mutual correlation within the mutual
correlation range; [0712] b) ranking the candidate biomarkers in
each group; and, [0713] c) selecting candidate biomarkers from the
different groups.
[0714] Typically the method includes: [0715] a) using reference
data for at least one individual to define a number of groups
indicative of the presence, absence, degree or prognosis of the at
least one condition; and, [0716] b) using at least one analysis
technique to identify a number of candidate biomarkers that are
potentially useful for distinguishing the groups.
[0717] Typically the method includes using reference values
measured for reference biomarkers for the at least one individual
to identify the candidate biomarkers.
[0718] Typically the method includes using reference values to
filter reference biomarkers to determine candidate biomarkers.
[0719] Typically at least one of the candidate biomarkers is a
derived biomarker derived from at least one of the reference
biomarkers using a function.
[0720] Typically the derived biomarkers are derived from filtered
biomarkers.
[0721] Typically the method includes: [0722] a) applying a function
to at least one of the reference values to determine at least one
derived reference biomarker value, the at least one derived
reference biomarker value being indicative of a value of a
corresponding derived reference biomarker; and, [0723] b)
determining at least one candidate biomarker using the at least one
derived reference biomarker value.
[0724] Typically the method includes: [0725] a) using reference
data for at least one individual to define a number of groups
indicative of the presence, absence, degree or prognosis of the at
least one condition; and, [0726] b) for each group, combining a
range of at least two reference biomarker values to determine an
indicator value range for the group.
[0727] Typically the mutual correlation range is at least one of:
[0728] a) .+-.0.8; [0729] b) .+-.0.7; [0730] c) .+-.0.6; [0731] d)
.+-.0.5; [0732] e) .+-.0.4; [0733] f) .+-.0.3; [0734] g) .+-.0.2;
and, [0735] h) .+-.0.1.
[0736] Typically each biomarker has a condition correlation with
the presence, absence, degree or prognosis of the at least one
condition that lies outside a condition correlation range, the
condition correlation range being between .+-.0.3.
[0737] Typically the condition correlation range is at least one
of: [0738] a) .+-.0.9; [0739] b) .+-.0.8; [0740] c) .+-.0.7; [0741]
d) .+-.0.6; [0742] e) .+-.0.5; and, [0743] f) .+-.0.4.
[0744] Typically the performance threshold is indicative of an
explained variance of at least one of: [0745] a) 0.4; [0746] b)
0.5; [0747] c) 0.6; [0748] d) 0.7; [0749] e) 0.8; and, [0750] f)
0.9.
[0751] In another broad form the present invention seeks to provide
apparatus for identifying markers for use in a diagnostic
signature, the diagnostic signature being for use in diagnosing the
presence, absence, degree or prognosis of at least one condition in
a biological subject, the apparatus including an electronic process
device that: [0752] a) for a number of candidate biomarkers, ranks
the candidate biomarkers in accordance with the ability of each
biomarker to distinguish between the presence, absence, degree or
prognosis of at least one condition in a biological subject; [0753]
b) selects at least two candidate biomarkers in accordance with the
ranking, the at least two biomarkers having a mutual correlation
for the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; [0754] c) determines a performance value of a combination
of the at least two candidate biomarkers; and, [0755] d) defines a
diagnostic signature in accordance with the combination of the at
least two biomarkers if the performance value is greater than or
equal to a performance threshold representing the ability of the
indicator to diagnose the presence, absence, degree or prognosis of
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3.
[0756] In another broad form the present invention seeks to provide
a method for diagnosing the presence or absence of inSIRS or a
healthy condition in a biological subject, the method comprising:
(a) determining a plurality of IRS biomarker values, each IRS
biomarker value being indicative of a value measured or derived for
at least one IRS biomarker of a biological subject; (b) determining
the indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from inSIRS and a healthy condition,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group A IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group B
IRS biomarker genes.
[0757] In another broad form the present invention seeks to provide
a method for diagnosing the presence or absence of ipSIRS or a
healthy condition in a biological subject, the method comprising:
(a) determining a plurality of IRS biomarker values, each IRS
biomarker value being indicative of a value measured or derived for
at least one IRS biomarker of a biological subject; (b) determining
the indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from ipSIRS and a healthy condition,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group C IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group D
IRS biomarker genes.
[0758] In another broad form the present invention seeks to provide
a method for diagnosing the presence or absence of inSIRS or ipSIRS
in a biological subject, the method comprising: (a) determining a
plurality of IRS biomarker values, each IRS biomarker value being
indicative of a value measured or derived for at least one IRS
biomarker of a biological subject; (b) determining the indicator
using a combination of the plurality of IRS biomarker values, the
at least one indicator being at least partially indicative of the
presence, absence, degree or prognosis of the at least one
condition selected from inSIRS and ipSIRS, wherein: (i) at least
two IRS biomarkers have a mutual correlation in respect of the at
least one condition that lies within a mutual correlation range,
the mutual correlation range being between .+-.0.9; and (ii) the
indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group E IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group F
IRS biomarker genes.
[0759] In another broad form the present invention seeks to provide
a method for diagnosing the presence or absence of inSIRS or ipSIRS
in a biological subject, the method comprising: (a) determining a
plurality of IRS biomarker values, each IRS biomarker value being
indicative of a value measured or derived for at least one IRS
biomarker of a biological subject; (b) determining the indicator
using a combination of the plurality of IRS biomarker values, the
at least one indicator being at least partially indicative of the
presence, absence, degree or prognosis of the at least one
condition selected from inSIRS and ipSIRS, wherein: (i) at least
four IRS biomarkers have a mutual correlation in respect of the at
least one condition that lies within a mutual correlation range,
the mutual correlation range being between .+-.0.9; and (ii) the
indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least four IRS biomarkers is selected from a first IRS biomarker
group, wherein at least one other of the at least four IRS
biomarkers is selected from a second IRS biomarker group, wherein
at least one other of the at least four IRS biomarkers is selected
from a third IRS biomarker group, and wherein at least one other of
the at least four IRS biomarkers is selected from a fourth IRS
biomarker group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group G
IRS biomarker genes, wherein the second IRS biomarker group
consists of polynucleotide and/or polypeptide expression products
from group H IRS biomarker genes, wherein the third IRS biomarker
group consists of polynucleotide and/or polypeptide expression
products from group I IRS biomarker genes and wherein the fourth
IRS biomarker group consists of polynucleotide and/or polypeptide
expression products from group J IRS biomarker genes.
[0760] Suitably, the first IRS biomarker is a PLA2G7 expression
product, the second IRS biomarker is a PLAC8 expression product,
the third IRS biomarker is a CEACAM4 expression product and the
fourth IRS biomarker is a LAMP1 expression product.
[0761] In another broad form the present invention seeks to provide
a method for diagnosing the presence or absence of mild sepsis or
severe sepsis in a biological subject, the method comprising: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one IRS biomarker of a biological subject; (b) determining the
indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from mild sepsis and severe sepsis,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group K IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group L
IRS biomarker genes.
[0762] In another form the present invention seeks to provide a
method for diagnosing the presence or absence of mild sepsis or
septic shock in a biological subject, the method comprising: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one IRS biomarker of a biological subject; (b) determining the
indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from mild sepsis and septic shock,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group M IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group N
IRS biomarker genes.
[0763] In another form the present invention seeks to provide a
method for diagnosing the presence or absence of severe sepsis or
septic shock in a biological subject, the method comprising: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one IRS biomarker of a biological subject; (b) determining the
indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from severe sepsis and septic shock,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group O IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group P
IRS biomarker genes.
[0764] In another broad form the present invention seeks to provide
a kit comprising: (i) a reagent that allows quantification of a
first IRS biomarker; and (ii) a reagent that allows quantification
of a second IRS biomarker, wherein the first and second IRS
biomarkers have a mutual correlation in respect of at least one
condition selected from a healthy condition, inSIRS, ipSIRS or a
stage of ipSIRS selected from mild sepsis, severe sepsis and septic
shock, which at least one condition lies within a mutual
correlation range of between .+-.0.9, and wherein a combination of
respective biomarker values for the first and second IRS biomarkers
that are measured for or derived from a biological subject has a
performance value greater than or equal to a performance threshold
representing the ability of the combination of the first and second
IRS biomarkers to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being a variance explained
of at least 0.3.
[0765] Suitably, the kit further comprises: (iii) a reagent that
allows quantification of a third IRS biomarker; and (iv) a reagent
that allows quantification of a fourth IRS biomarker, wherein the
third and fourth IRS biomarkers have a mutual correlation in
respect of at the least one condition that lies within a mutual
correlation range of between .+-.0.9, and wherein a combination of
respective biomarker values for the third and fourth IRS biomarkers
that are measured for or derived from a biological subject has a
performance value greater than or equal to a performance threshold
representing the ability of the combination of the third and fourth
IRS biomarkers to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being a variance explained
of at least 0.3.
[0766] Suitably, the kit is for diagnosing the presence or absence
of inSIRS or a healthy condition, wherein the first IRS biomarker
is selected from a first IRS biomarker group and wherein the second
IRS biomarker is selected from a second IRS biomarker group,
wherein the first IRS biomarker group consists of polynucleotide
and/or polypeptide expression products from group A IRS biomarker
genes and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group B
IRS biomarker genes.
[0767] Suitably, the kit is for diagnosing the presence or absence
of ipSIRS or a healthy condition, wherein the first IRS biomarker
is selected from a first IRS biomarker group and wherein the second
IRS biomarker is selected from a second IRS biomarker group,
wherein the first IRS biomarker group consists of polynucleotide
and/or polypeptide expression products from group C IRS biomarker
genes and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group D
IRS biomarker genes.
[0768] Suitably, the kit is for diagnosing the presence or absence
of inSIRS or ipSIRS, wherein the first IRS biomarker is selected
from a first IRS biomarker group and wherein the second IRS
biomarker is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group E IRS biomarker genes
and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group F
IRS biomarker genes.
[0769] Suitably, the kit is for diagnosing the presence or absence
of inSIRS or ipSIRS, wherein the first IRS biomarker is selected
from a first IRS biomarker group, wherein the second IRS biomarker
is selected from a second IRS biomarker group, wherein the third
IRS biomarker is selected from a third IRS biomarker group and
wherein the fourth IRS biomarker is selected from a fourth IRS
biomarker group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group G
IRS biomarker genes, wherein the second IRS biomarker group
consists of polynucleotide and/or polypeptide expression products
from group H IRS biomarker genes, wherein the third IRS biomarker
group consists of polynucleotide and/or polypeptide expression
products from group I IRS biomarker genes and wherein the fourth
IRS biomarker group consists of polynucleotide and/or polypeptide
expression products from group J IRS biomarker genes.
[0770] Suitably, the first IRS biomarker is a PLA2G7 expression
product, the second IRS biomarker is a PLAC8 expression product,
the third IRS biomarker is a CEACAM4 expression product and the
fourth IRS biomarker is a LAMP1 expression product.
[0771] Suitably, the kit is for diagnosing the presence or absence
of mild sepsis or severe sepsis, wherein the first IRS biomarker is
selected from a first IRS biomarker group and wherein the second
IRS biomarker is selected from a second IRS biomarker group,
wherein the first IRS biomarker group consists of polynucleotide
and/or polypeptide expression products from group K IRS biomarker
genes and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group L
IRS biomarker genes.
[0772] Suitably, the kit is for diagnosing the presence or absence
of mild sepsis or septic shock, wherein the first IRS biomarker is
selected from a first IRS biomarker group and wherein the second
IRS biomarker is selected from a second IRS biomarker group,
wherein the first IRS biomarker group consists of polynucleotide
and/or polypeptide expression products from group M IRS biomarker
genes and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group N
IRS biomarker genes.
[0773] Suitably, the kit is for diagnosing the presence or absence
of severe sepsis or septic shock, wherein the first IRS biomarker
is selected from a first IRS biomarker group and wherein the second
IRS biomarker is selected from a second IRS biomarker group,
wherein the first IRS biomarker group consists of polynucleotide
and/or polypeptide expression products from group O IRS biomarker
genes and wherein the second IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group P
IRS biomarker genes.
[0774] In another broad form the present invention seeks to provide
a method for treating, preventing or inhibiting the development of
at least one condition selected from inSIRS, ipSIRS or a particular
stage of ipSIRS (e.g., mild sepsis, severe sepsis or septic shock)
in a subject, the method comprising (a) determining a plurality of
IRS biomarker values, each IRS biomarker value being indicative of
a value measured or derived for at least one IRS biomarker of a
biological subject; (b) determining an indicator using a
combination of the plurality of IRS biomarker values, the indicator
being at least partially indicative of the presence, absence or
degree of the at least one condition, wherein: (i) at least two IRS
biomarkers have a mutual correlation in respect of the at least one
condition that lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; and (ii) the indicator has
a performance value greater than or equal to a performance
threshold representing the ability of the indicator to diagnose the
presence, absence or degree of the at least one condition, the
performance threshold being indicative of an explained variance of
at least 0.3; and (c) administering to the subject, on the basis
that the indicator indicates the presence of inSIRS, an effective
amount of an agent that treats or ameliorates the symptoms or
reverses or inhibits the development of inSIRS, or administering to
the subject, on the basis that the indicator indicates the presence
of ipSIRS or a particular stage of ipSIRS, an effective amount of
an agent that treats or ameliorates the symptoms or reverses or
inhibits the development of ipSIRS or the particular stage of
ipSIRS.
[0775] Suitably, the method further comprises: (1) determining a
plurality of measured IRS biomarker values, each measured IRS
biomarker value being a measured value of an IRS biomarker of the
biological subject; and (2) applying a function to at least one of
the measured IRS biomarker values to determine at least one derived
IRS biomarker value, the at least one derived IRS biomarker value
being indicative of a value of a corresponding derived IRS
biomarker.
[0776] Suitably, the function includes at least one of: (a)
multiplying two IRS biomarker values; (b) dividing two IRS
biomarker values; (c) adding two IRS biomarker values; (d)
subtracting two IRS biomarker values; (e) a weighted sum of at
least two IRS biomarker values; (f) a log sum of at least two IRS
biomarker values; and (g) a sigmoidal function of at least two IRS
biomarker values.
[0777] In another broad form the present invention seeks to provide
a method of monitoring the efficacy of a particular treatment
regimen in a subject towards a desired health state, the method
comprising: a) determining a plurality of IRS biomarker values,
each IRS biomarker value being indicative of a value measured or
derived for at least one IRS biomarker of a biological subject
after treatment with a treatment regimen; (b) determining an
indicator using a combination of the plurality of IRS biomarker
values, the indicator being at least partially indicative of the
presence, absence or degree of at least one condition selected from
a healthy condition, inSIRS, ipSIRS or a particular stage of
ipSIRS, wherein: (i) at least two IRS biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the indicator has a performance
value greater than or equal to a performance threshold representing
the ability of the indicator to diagnose the presence, absence or
degree of the at least one condition, or to provide a prognosis for
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3, and (c)
determining that the treatment regimen is effective for changing
the health status of the subject to the desired health state on the
basis that the indicator indicates the presence of a healthy
condition or the presence of a condition of a lower degree relative
to the degree of the condition in the subject before treatment with
the treatment regimen.
[0778] In another broad form the present invention seeks to provide
a method of correlating a biomarker signature with an effective
treatment regimen for a condition selected from inSIRS, ipSIRS or a
particular stage of ipSIRS (e.g., mild sepsis, severe sepsis and
septic shock), the method comprising: (a) determining a biomarker
signature defining a combination of at least two IRS biomarker
values corresponding to values of at least two IRS biomarkers that
can be measured for or derived from a biological subject having the
condition and for whom an effective treatment has been identified,
wherein: (i) the at least two IRS biomarkers have a mutual
correlation in respect of the condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the combination of at least two biomarker values
has a performance value greater than or equal to a performance
threshold representing the ability of the combination of at least
two biomarker values to diagnose the presence, absence or degree of
the condition, or to provide a prognosis for the condition, the
performance threshold being indicative of an explained variance of
at least 0.3; and (b) correlating the biomarker signature so
determined with an effective treatment regimen for the
condition.
[0779] In another broad form the present invention seeks to provide
a method of determining whether a treatment regimen is effective
for treating a subject with a condition selected from inSIRS,
ipSIRS or a particular stage of ipSIRS (e.g., mild sepsis, severe
sepsis and septic shock), the method comprising: (a) determining a
plurality of post-treatment IRS biomarker values, each
post-treatment IRS biomarker value being indicative of a value
measured or derived for at least one IRS biomarker of a biological
subject after treatment with the treatment regimen; (b) determining
a post-treatment indicator using a combination of the plurality of
post-treatment IRS biomarker values, the post-treatment indicator
being at least partially indicative of the presence, absence or
degree of at least one condition selected from a healthy condition,
inSIRS, ipSIRS or a particular stage of ipSIRS, wherein: (i) at the
least two IRS biomarkers have a mutual correlation in respect of
the at least one condition that lies within a mutual correlation
range, the mutual correlation range being between .+-.0.9; and (ii)
the post-treatment indicator has a performance value greater than
or equal to a performance threshold representing the ability of the
post-treatment indicator to diagnose the presence, absence or
degree of the at least one condition, the performance threshold
being indicative of an explained variance of at least 0.3, wherein
the post-treatment indicator indicates whether the treatment
regimen is effective for treating the condition in the subject on
the basis that post-treatment indicator indicates the presence of a
healthy condition or the presence of a condition of a lower degree
relative to the degree of the condition in the subject before
treatment with the treatment regimen.
[0780] In another broad form the present invention seeks to provide
a method of correlating a biomarker signature with a positive or
negative response or a side effect to a treatment regimen, the
method comprising: (a) determining a biomarker signature defining a
combination of at least two IRS biomarker values corresponding to
values of at least two IRS biomarkers that can be measured for or
derived from a biological subject following commencement of the
treatment regimen, wherein: (i) the at least two IRS biomarkers
have a mutual correlation in respect of at least one condition
selected from a healthy condition, inSIRS, ipSIRS or a particular
stage of ipSIRS (e.g., mild sepsis, severe sepsis and septic
shock), which lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; and (ii) the combination
of at least two biomarker values has a performance value greater
than or equal to a performance threshold representing the ability
of the combination of at least two biomarker values to diagnose the
presence, absence or degree of the at least one condition, or to
provide a prognosis for the at least one condition, the performance
threshold being indicative of an explained variance of at least
0.3; and (b) correlating the biomarker signature so determined with
a positive or negative response to the treatment regimen.
[0781] In another broad form the present invention seeks to provide
a method of determining a positive or negative response to a
treatment regimen and/or a side effect of a treatment regimen by a
subject with a condition selected from inSIRS, ipSIRS or a
particular stage of ipSIRS (e.g., mild sepsis, severe sepsis and
septic shock), the method: (a) correlating a reference biomarker
signature with a positive or negative response or a side effect to
the treatment regimen, wherein the biomarker signature defines a
combination of at least two IRS biomarker values corresponding to
values of at least two IRS biomarkers that are measured for or
derived from a control biological subject or control group,
wherein: (i) the at least two IRS biomarkers have a mutual
correlation in respect of at least one condition selected from a
healthy condition, inSIRS, ipSIRS or a particular stage of ipSIRS
(e.g., mild sepsis, severe sepsis and septic shock), which lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the combination of at least two
biomarker values has a performance value greater than or equal to a
performance threshold representing the ability of the combination
of at least two biomarker values to diagnose the presence, absence
or degree of the at least one condition, or to provide a prognosis
for the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3; (b)
determining a sample biomarker signature defining a combination of
at least two IRS biomarker values corresponding to values of at
least two IRS biomarkers that are measured for or derived from a
biological subject following commencement of the treatment regimen,
wherein: (i) the at least two IRS biomarkers have a mutual
correlation in respect of at least one condition selected from a
healthy condition, inSIRS, ipSIRS or a particular stage of ipSIRS,
which lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9; and (ii) the combination
of at least two biomarker values has a performance value greater
than or equal to a performance threshold representing the ability
of the combination of at least two biomarker values to diagnose the
presence, absence or degree of the at least one condition, or to
provide a prognosis for the at least one condition, the performance
threshold being indicative of an explained variance of at least
0.3; wherein the sample biomarker signature indicates whether the
subject is responding positively or negatively to the treatment
regimen and/or is developing a side effect from the treatment
regimen, based on the correlation of the reference biomarker
signature with the positive or negative response or side effect to
the treatment regimen.
[0782] In another broad form the present invention seeks to provide
a method of determining a positive or negative response to a
treatment regimen and/or a side effect to a treatment regimen by a
biological subject, the method comprising: (a) determining a sample
biomarker signature defining a combination of at least two IRS
biomarker values corresponding to values of at least two IRS
biomarkers that are measured for or derived from a biological
subject following commencement of the treatment regimen, wherein:
(i) the at least two IRS biomarkers have a mutual correlation in
respect of at least one condition selected from a healthy
condition, inSIRS, ipSIRS or a particular stage of ipSIRS (e.g.,
mild sepsis, severe sepsis and septic shock), which lies within a
mutual correlation range, the mutual correlation range being
between .+-.0.9; and (ii) the combination of at least two biomarker
values has a performance value greater than or equal to a
performance threshold representing the ability of the combination
of at least two biomarker values to diagnose the presence, absence
or degree of the at least one condition, or to provide a prognosis
for the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3, wherein the
sample biomarker signature is correlated with a positive or
negative response to the treatment regimen and/or to a side effect
from the treatment regimen; and (b) determining whether the subject
is responding positively or negatively to the treatment regimen
and/or is developing a side effect from the treatment regimen based
on the sample biomarker signature.
BRIEF DESCRIPTION OF THE DRAWINGS
[0783] An example of the present invention will now be described
with reference to the accompanying drawings, in which:--
[0784] FIG. 1A is a flowchart of an example of a method for
deriving an indicator for use in diagnosing the presence, absence
or degree of at least one condition or in providing a prognosis of
at least one condition in a biological subject;
[0785] FIG. 1B is a flowchart of an example of a method for
identifying biomarkers for use in a biomarker signature;
[0786] FIG. 2 is a schematic diagram of an example of a distributed
computer architecture;
[0787] FIG. 3 is a schematic diagram of an example of a processing
system of FIG. 2;
[0788] FIG. 4 is a schematic diagram of an example of a computer
system of FIG. 2;
[0789] FIG. 5 is a flowchart of a specific example of a method for
identifying biomarkers for use in a biomarker signature;
[0790] FIG. 6A is a flowchart of a first example of a method for
selecting candidate biomarkers;
[0791] FIG. 6B is a flowchart of a second example of a method for
selecting candidate biomarkers;
[0792] FIG. 7 is a flowchart of a second example of a method for
use in diagnosing the presence, absence or degree of at least one
condition or in providing a prognosis of at least one condition in
a biological subject;
[0793] FIG. 8A is a plot of 941 mRNA biomarkers against the AUC for
differentiating between healthy condition and post-surgical
inflammation (PS) (also referred to herein as "infection-negative
SIRS" (inSIRS)), for individual biomarkers having an AUC greater
than 0.7;
[0794] FIG. 8B is a box and whisker plot showing the best mRNA
biomarker for separating healthy condition and PS;
[0795] FIG. 8C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating healthy condition and PS with
all derived biomarkers having an AUC of 1.0;
[0796] FIG. 8D is a box and whisker plot of the best performing
derived biomarker, based on AUC, for separating healthy condition
and PS;
[0797] FIGS. 8E and 8F are two plots showing the correlation to
each other of the biomarkers in each group;
[0798] FIGS. 8G and 8H are two plots demonstrating the AUC of the
biomarkers in each group (groups 1 and 2);
[0799] FIG. 8I is a box and whisker plot showing that when
biomarkers are derived from group 1 and group 2 that a greater
overall AUC is obtained;
[0800] FIG. 9A is a plot of the 941 mRNA biomarkers against the AUC
for differentiating between healthy condition and sepsis (also
referred to herein as "infection-positive SIRS" (ipSIRS)) with all
individual biomarkers having an AUC greater than 0.7;
[0801] FIG. 9B is a box and whisker plot showing the best mRNA
biomarker for separating healthy condition and sepsis;
[0802] FIG. 9C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating healthy condition and sepsis
with all derived biomarkers having an AUC of 1.0;
[0803] FIG. 9D is a box and whisker plot of the best performing
derived biomarker, based on AUC, for separating healthy condition
and sepsis;
[0804] FIGS. 9E and 9F show the correlation to each other of the
biomarkers groups correlated to each group;
[0805] FIGS. 9G and 9H are two plots demonstrating the AUC of the
biomarkers in each group (bucketgroups 1 and 2);
[0806] FIG. 9I is a box and whisker plot showing that when
biomarkers are derived from bucketgroup 1 and bucketgroup 2 that a
greater overall AUC is obtained;
[0807] FIG. 10A is a plot of the 359 mRNA biomarkers against the
AUC for differentiating between PS and sepsis with all individual
biomarkers having had an AUC greater than 0.7;
[0808] FIG. 10B is a box and whisker plot showing the best mRNA
biomarker for separating PS and sepsis;
[0809] FIG. 10C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating PS and sepsis with all
derived biomarkers having an AUC of 0.9;
[0810] FIG. 10D is a box and whisker plot of the best derived
biomarker for separating PS and sepsis;
[0811] FIG. 10E is a plot showing the correlation of the biomarkers
in each bucketgroup to the condition;
[0812] FIG. 10F is a box and whisker plot showing that when
biomarkers are derived from bucketgroup 1 and bucketgroup 2 that a
greater overall AUC is obtained;
[0813] FIG. 10G is a plot demonstrating the AUC of the biomarkers
in each of four bucketgroups;
[0814] FIG. 10H is a box and whisker plot showing that when
biomarkers are derived from each of the four bucketgroups a greater
overall AUC is obtained;
[0815] FIG. 11A is a plot of the 66 mRNA biomarkers against the AUC
for differentiating between mild sepsis and severe sepsis with all
individual biomarkers selected having an AUC greater than 0.7;
[0816] FIG. 11B is a box and whisker plot showing the best mRNA
biomarker for separating mild sepsis and severe sepsis;
[0817] FIG. 11C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating mild sepsis and severe sepsis
with all derived biomarkers have an AUC of at least 0.87;
[0818] FIG. 11D is a box and whisker plot of the best performing
derived biomarker, based on AUC, for separating mild sepsis and
severe sepsis;
[0819] FIGS. 11E and 11F are plots showing the correlation to each
other of the biomarkers in each group;
[0820] FIGS. 11G and 11H are plots demonstrating the AUC of the
biomarkers in each group;
[0821] FIG. 11I is a box and whisker plot showing that when
biomarkers are derived from group 1 and group 2 that a greater
overall AUC is obtained;
[0822] FIG. 12A is a plot of the 48 mRNA biomarkers against the AUC
for differentiating between mild sepsis and septic shock (also
referred to herein as "infection-positive SIRS-shock"
(ipSIRS-shock)) with all individual biomarkers having an AUC
greater than 0.7;
[0823] FIG. 12B is a box and whisker plot showing the best mRNA
biomarker for separating mild sepsis and septic shock;
[0824] FIG. 12C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating mild sepsis and septic shock
with all derived biomarkers having an AUC of at least 0.793;
[0825] FIG. 12D is a box and whisker plot of the best performing
derived biomarker, based on AUC, for separating mild sepsis and
septic shock;
[0826] FIGS. 12E and 12F are plots showing the correlation to each
other of the biomarkers in each group;
[0827] FIGS. 12G and 12H are plots demonstrating the AUC of the
biomarkers in each group;
[0828] FIG. 12I is a box and whisker plot showing that when
biomarkers are derived from group 1 and group 2 that a greater
overall AUC is obtained;
[0829] FIG. 13A is a plot of the 61 mRNA biomarkers against the AUC
for differentiating between severe sepsis and septic shock with all
individual biomarkers selected having an AUC greater than 0.7;
[0830] FIG. 13B is a box and whisker plot showing the best mRNA
biomarker for separating severe sepsis and septic shock;
[0831] FIG. 13C is a plot of the AUC for the diagnostic ability of
1000 derived biomarkers in separating severe sepsis and septic
shock with all derived biomarkers have an AUC of at least
0.821;
[0832] FIG. 13D is a box and whisker plot of the best performing
derived biomarker, based on AUC, for separating severe sepsis and
septic shock;
[0833] FIGS. 13E and 13F are plots showing the correlation to each
other of the biomarkers in each group;
[0834] FIGS. 13G and 13H are plots demonstrating the AUC of the
biomarkers in each group;
[0835] FIG. 13I is a box and whisker plot showing that when
biomarkers are derived from group 1 and group 2 that a greater
overall AUC is obtained;
[0836] FIG. 14 is a user interface illustrating an example of a
thermal cycler protocol;
[0837] FIG. 15 is a diagram of an example of a report; and,
[0838] FIGS. 16A to 16L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between healthy
condition and PS;
[0839] FIGS. 17A to 17L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between healthy
condition and sepsis;
[0840] FIGS. 18A to 18L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between PS and
sepsis;
[0841] FIGS. 19A to 19L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between sepsis and
severe sepsis;
[0842] FIGS. 20A to 20L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between severe
sepsis and septic shock;
[0843] FIGS. 21A to 21L are box and whisker plots for the top
twelve biomarker combinations for distinguishing between sepsis and
septic shock;
[0844] FIG. 22 is a graph of the effect on AUC of adding biomarkers
to a biomarker signature;
[0845] FIG. 23 is a graph showing an example of the ability of the
biomarker signature to distinguish between PS and sepsis for two
patient populations;
[0846] FIG. 24 is a flowchart of an example of a method for
determining indicator references;
[0847] FIGS. 25A and 25B are a flowchart of an example of a method
for validating an indicator derived from biomarker
measurements;
[0848] FIG. 26 is an example showing the comparison of an indicator
value to an indicator reference; and,
[0849] FIGS. 27A and 27B are example representation of indicator
values.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0850] An example of a method for determining an indicator for use
in diagnosing the presence, absence or degree of at least one
condition in or of a biological subject, or in monitoring the
progression of at least one condition in or of the subject, or in
prognosing at least one condition in or of the subject, will now be
described with reference to FIG. 1A.
[0851] For the purpose of explanation, a number of different terms
will be used. For example, the term "biomarker" refers to a
measurable parameter, or combination of parameters, that can be
used as an indicator of a biological state and includes, without
limitation, proteins, nucleic acids, carbohydrates, lipids,
metabolites, gases, steroids, ions, nutrients, toxins, cells,
pathogenic organisms, non-pathogenic organisms, organic compounds
and inorganic compounds. Biomarkers also encompass non-blood-borne
factors, non-analyte physiological markers of health status, or
other factors or biomarkers not measured from samples (e.g.,
biological samples such as bodily fluids), such as "clinical" or
"phenotypic" parameters, including, without limitation, age,
ethnicity, gender, species, breed, genetic information, white blood
cell count, diastolic blood pressure and systolic blood pressure,
bone density, height, weight, waist and hip circumference,
body-mass index, as well as others such as Type I or Type II
diabetes mellitus or gestational diabetes mellitus (collectively
referred to here as diabetes), resting heart rate, homeostatic
model assessment (HOMA), HOMA insulin resistance (HOMA-IR),
intravenous glucose tolerance (SI(IVGT)), resting heart rate,
.beta. cell function, macrovascular function, microvascular
function, atherogenic index, low-density lipoprotein/high-density
lipoprotein ratio, intima-media thickness, body temperature,
sequential organ failure assessment (SOFA) and the like. The
"biomarkers" could also include "immune response biomarkers", which
will be described in more detail below.
[0852] The term "biomarker value" refers to a value measured or
derived for at least one corresponding biomarker of the biological
subject and which is typically at least partially indicative of a
concentration of the immune system biomarker in a sample taken from
the subject. Thus, the biomarker values could be measured biomarker
values, which are values of biomarkers measured for the subject, or
alternatively could be derived biomarker values, which are values
that have been derived from one or more measured biomarker values,
for example by applying a function to the one or more measured
biomarker values.
[0853] Biomarker values can be of any appropriate form depending on
the manner in which the values are determined. For example, the
biomarker values could be determined using high-throughput
technologies such as mass spectrometry, sequencing platforms, array
and hybridization platforms, immunoassays, flow cytometry, or any
combination of such technologies and in one preferred example, the
biomarker values relate to a level of activity or abundance of an
expression product or other measurable molecule, quantified using a
technique such as PCR, sequencing or the like. In this case, the
biomarker values can be in the form of amplification amounts, or
cycle times, which are a logarithmic representation of the
concentration of the biomarker within a sample, as will be
appreciated by persons skilled in the art and as will be described
in more detail below.
[0854] The term "reference biomarkers" is used to refer to
biomarkers whose activity has been quantified for a sample
population of one or more individuals having one or more
conditions, stages of one or more conditions, subtypes of one or
more conditions or different prognoses. The term "reference data"
refers to data measured for one or more individuals in a sample
population, and may include quantification of the level or activity
of the biomarkers measured for each individual, information
regarding any conditions of the individuals, and optionally any
other information of interest.
[0855] The term "candidate biomarkers" refers to a subset of the
reference biomarkers that have been identified as being potentially
useful in distinguishing between different groups of individuals,
such as individuals suffering from different conditions, or having
different stages or prognoses. The number of candidate biomarkers
will vary, but is typically about 200.
[0856] The term "signature biomarkers" is used to refer to a subset
of the candidate biomarkers that have been identified for use in a
biomarker signature that can be used in performing a clinical
assessment, such as to rule in or rule out a specific condition,
different stages or severity of conditions, subtypes of different
conditions or different prognoses. The number of signature
biomarkers will vary, but is typically of the order of 10 or
less.
[0857] The term "biomarker signature" means a combination of at
least two biomarker values corresponding to values of biomarkers
that can be measured for or derived from one or more biological
subjects, which combination is characteristic for a discrete
condition, stage of condition, subtype of condition or a prognosis
for a discrete condition, stage of condition, subtype of
condition.
[0858] The terms "biological subject", "subject", "individual" and
"patient" are used interchangeably herein to refer to an animal
subject, particularly a vertebrate subject, and even more
particularly a mammalian subject. Suitable vertebrate animals that
fall within the scope of the invention include, but are not
restricted to, any member of the phylum Chordata, subphylum
vertebrata including primates, rodents (e.g., mice rats, guinea
pigs), lagomorphs (e.g., rabbits, hares), bovines (e.g., cattle),
ovines (e.g., sheep), caprines (e.g., goats), porcines (e.g.,
pigs), equines (e.g., horses), canines (e.g., dogs), felines (e.g.,
cats), avians (e.g., chickens, turkeys, ducks, geese, companion
birds such as canaries, budgerigars etc.), marine mammals (e.g.,
dolphins, whales), reptiles (snakes, frogs, lizards, etc.), and
fish. A preferred subject is a primate (e.g., a human, ape, monkey,
chimpanzee).
[0859] As used herein, the term SIRS ("systemic inflammatory
response syndrome") refers to a clinical response arising from a
non-specific insult with two or more of the following measurable
clinical characteristics; a body temperature greater than
38.degree. C. or less than 36.degree. C., a heart rate greater than
90 beats per minute, a respiratory rate greater than 20 per minute,
a white blood cell count (total leukocytes) greater than 12,000 per
mm.sup.3 or less than 4,000 per mm.sup.3, or a band neutrophil
percentage greater than 10%. From an immunological perspective, it
may be seen as representing a systemic response to insult (e.g.,
major surgery) or systemic inflammation. As used herein, "inSIRS"
(which includes within its scope "post-surgical" (PS) inflammation)
includes the clinical response noted above but in the absence of a
systemic infectious process. By contrast, "ipSIRS" (also referred
to herein as "sepsis") includes the clinical response noted above
but in the presence of a presumed or confirmed infection.
Confirmation of infection can be determined using microbiological
culture or isolation of the infectious agent. From an immunological
perspective, ipSIRS may be seen as a systemic response to
microorganisms, whether it is a local, peripheral or systemic
infection.
[0860] As used herein, the term "degree" of a condition refers to
the seriousness, severity, stage or state of a condition. For
example, a condition may be characterized as mild, moderate or
severe. A person of skill in the art would be able to determine or
assess the degree of a particular condition. For example, the
degree of a condition may be determined by comparing the likelihood
or length of survival of a subject having a condition with the
likelihood or length of survival in other subjects having the same
condition. In other embodiments, the degree of a condition may be
determined by comparing the clinical signs of a subject having a
condition with the degree of the clinical signs in other subjects
having the same condition.
[0861] It will be appreciated that the above described terms and
associated definitions are used for the purpose of explanation only
and are not intended to be limiting.
[0862] In this example, the method includes determining a plurality
of biomarker values at step 100, each biomarker value being
indicative of a value measured or derived for at least one
biomarker of the biological subject.
[0863] The biomarker values and biomarkers corresponding to the
biomarker values can be of any appropriate form and in particular
can relate to any attribute of a subject for which a value can be
quantified. This technique is particularly suited to
high-throughput technologies such as mass spectrometry, sequencing
platforms, array and hybridization platforms, or any combination of
such technologies and in one preferred example, the biomarker
values relate to a level of activity or abundance of an expression
product or other measurable molecule.
[0864] The biomarker values could be measured biomarker values,
which are values of biomarkers measured for the subject, or
alternatively could be derived biomarker values, which are values
that have been derived from one or more measured biomarker values,
for example by applying a function to the one or more measured
biomarker values. As used herein, biomarkers to which a function
has been applied are referred to as "derived markers".
[0865] The biomarker values may be determined in any one of a
number of ways. In one example, the process of determining the
biomarker values can include measuring the biomarker values, for
example by performing tests on the biological subject. More
typically however, the step of determining the biomarker values
includes having an electronic processing device receive or
otherwise obtain biomarker values that have been previously
measured or derived. This could include for example, retrieving the
biomarker values from a data store such as a remote database,
obtaining biomarker values that have been manually input, using an
input device, or the like.
[0866] At step 110, the indicator is determined using a combination
of the plurality of biomarker values, the indicator being at least
partially indicative of the presence, absence, degree or prognosis
of the at least one condition.
[0867] The biomarker values can be combined in any one of a number
of ways and this can include for example adding, multiplying,
subtracting, or dividing biomarker values to determine an indicator
value. This step is performed so that multiple biomarker values can
be combined into a single indicator value, providing a more useful
and straightforward mechanism for allowing the indicator to be
interpreted and hence used in diagnosing the presence, absence or
degree of the at least one condition in the subject, or prognosing
the at least one condition in the subject.
[0868] Assuming the method is performed using an electronic
processing device, at step 120 an indication of the indicator is
optionally displayed or otherwise provided to the user. In this
regard, the indication could be a graphical or alphanumeric
representation of an indicator value. Alternatively however, the
indication could be the result of a comparison of the indicator
value to predefined thresholds or ranges, or alternatively could be
an indication of the presence, absence, degree or prognosis for at
least one condition, derived using the indicator.
[0869] In order to ensure an effective diagnosis or prognosis can
be determined, at least two of the biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9. This requirement means that the two
biomarkers are not entirely correlated in respect of each other
when considered in the context of the condition(s) being diagnosed
or prognosed. In other words, at least two of the biomarkers in the
combination respond differently as the condition changes, which
adds significantly to their ability when combined to discriminate
between at least two conditions, to diagnose the presence, absence
or degree of at least one condition, and/or to provide a prognosis
of at least condition in or of the biological subject. As used
herein, "and/or" refers to and encompasses any and all possible
combinations of one or more of the associated listed items, as well
as the lack of combinations when interpreted in the alternative
(or).
[0870] Typically, the requirement that biomarkers have a low mutual
correlation means that the biomarkers may relate to different
biological attributes or domains such as but not limited to
different molecular functions, different biological processes and
different cellular components. Illustrative examples of molecular
function include addition of or removal of one of more of the
following moieties to or from a protein, polypeptide, peptide,
nucleic acid (e.g., DNA, RNA): linear, branched, saturated or
unsaturated alkyl (e.g., C.sub.1-C.sub.24 alkyl); phosphate;
ubiquitin; acyl; fatty acid, lipid, phospholipid; nucleotide base;
hydroxyl and the like. Molecular functions also include signaling
pathways, including without limitation, receptor signaling pathways
and nuclear signaling pathways. Non-limiting examples of molecular
functions also include cleavage of a nucleic acid, peptide,
polypeptide or protein at one or more sites; polymerization of a
nucleic acid, peptide, polypeptide or protein; translocation
through a cell membrane (e.g., outer cell membrane; nuclear
membrane); translocation into or out of a cell organelle (e.g.,
Golgi apparatus, lysosome, endoplasmic reticulum, nucleus,
mitochondria); receptor binding, receptor signaling, membrane
channel binding, membrane channel influx or efflux; and the
like.
[0871] Illustrative examples of biological processes include:
stages of the cell cycle such as meiosis, mitosis, cell division,
prophase, metaphase, anaphase, telophase and interphase, stages of
cell differentiation; apoptosis; necrosis; chemotaxis; immune
responses including adaptive and innate immune responses,
pro-inflammatory immune responses, autoimmune responses,
tolerogenic responses and the like. Other illustrative examples of
biological processes include generating or breaking down adenosine
triphosphate (ATP), saccharides, polysaccharides, fatty acids,
lipids, phospholipids, sphingolipids, glycolipids, cholesterol,
nucleotides, nucleic acids, membranes (e.g., cell plasma membrane,
nuclear membrane), amino acids, peptides, polypeptides, proteins
and the like.
[0872] Representative examples of cellular components include
organelles, membranes, as for example noted above, and others.
[0873] It will be appreciated that the use of biomarkers that have
different biological attributes or domains provides further
information than if the biomarkers were related to the same or
common biological attributes or domains.
[0874] In this regard, it will be appreciated if the at least two
biomarkers are highly correlated to each other, the use of both
biomarkers would add little diagnostic/prognostic improvement
compared to the use of a single one of the biomarkers. Accordingly,
the method uses biomarkers that are not well correlated with each
other, thereby ensuring that the inclusion of each biomarker in the
method adds significantly to the discriminative ability of the
indicator.
[0875] Despite this, in order to ensure that the indicator can
accurately be used in performing the discrimination between at
least two conditions or the diagnosis of the presence, absence or
degree of at least one condition or the prognosis of at least one
condition, the indicator has a performance value that is greater
than or equal to a performance threshold. The performance threshold
may be of any suitable form but is to be typically indicative of an
explained variance of at least 0.3, or an equivalent value of
another performance measure.
[0876] It has been found that utilizing a combination of biomarkers
that have a mutual correlation between .+-.0.9 and using these in a
combination that provides an explained variance of at least 0.3,
this allows an indicator to be defined that is suitable for
ensuring that an accurate discrimination, diagnosis or prognosis
can be obtained whilst minimizing the number of biomarkers that are
required.
[0877] It will be appreciated that in this context, the biomarkers
used within the above-described method can define a biomarker
signature for the at least one condition, which includes a minimal
number of biomarkers, whilst maintaining sufficient performance to
allow the biomarker signature to be used in making a clinically
relevant diagnosis, prognosis, or differentiation. Minimizing the
number of biomarkers used minimizes the costs associated with
performing diagnostic or prognostic tests and in the case of
nucleic acid expression products, allows the test to be performed
utilizing relatively straightforward techniques such as nucleic
acid array, and polymerase chain reaction (PCR) processes, or the
like, allowing the test to be performed rapidly in a clinical
environment.
[0878] Furthermore, producing a single indicator value allows the
results of the test to be easily interpreted by a clinician or
other medical practitioner, so that test can be used for reliable
diagnosis in a clinical environment.
[0879] An example of the process for generating a suitable
biomarker signature for use in the method of FIG. 1A will now be
described with reference to FIG. 1B.
[0880] In particular, it is typical to generate a biomarker
signature by analyzing a large number of biomarkers and then
selecting a combination of biomarkers that meet the above described
criteria.
[0881] In this example, at step 150 the process includes ranking a
number of candidate biomarkers in accordance with the ability of
each biomarker to distinguish between the presence, absence, degree
or prognosis of at least one condition in a biological subject.
[0882] The candidate biomarkers can be obtained in any appropriate
matter, but typically this would involve acquiring reference data
including reference biomarker values relating to a number of
reference biomarkers that have been measured or derived for one or
more reference individuals having different presences, absences,
degrees or prognoses of the one or more conditions of interest.
Thus, it will be appreciated that the candidate biomarkers can
include measured and/or derived biomarkers, as will be described in
more detail below.
[0883] The reference data typically includes measurements of a
plurality of reference biomarkers, the measurements including
information regarding the activity, such as the level, abundance or
functional activity, of any expression product or measurable
molecule, as will be described in more detail below. The reference
data may also include information such as clinical data regarding
one or more conditions suffered by each individual. This can
include information regarding a presence, absence, degree or
progression of a condition, phenotypic information, such as details
of phenotypic traits, genetic or genetically regulated information,
amino acid or nucleotide related genomics information, results of
other tests including imaging, biochemical and hematological
assays, other physiological scores such as a SOFA (Sequential Organ
Failure Assessment) score, or the like and this is not intended to
be limiting, as will be apparent from the description below.
[0884] The candidate biomarkers can include some or all of the
reference biomarkers, depending on the preferred implementation.
Thus, for example, reference biomarker values could be analyzed to
determine correlations between the reference biomarkers and the at
least one condition, with the reference biomarkers being coarsely
filtered to remove those with a low correlation, for example with a
correlation with the condition that is below 0.3.
[0885] At step 160 at least two candidate biomarkers are selected
based on the ranking and a mutual correlation. In particular, at
least two candidate biomarkers are selected which have a mutual
correlation within a mutual correlation range of .+-.0.9. Thus,
this process excludes any biomarkers which are highly mutually
correlated, when considered in the context of the one or more
conditions, and which would not therefore add significantly to the
ability to discriminate between the presence, absence, degree or
prognosis of at least one condition.
[0886] At step 170 a performance value of a combination of the
selected candidate biomarkers is determined. As mentioned above the
combination may be any combination of the candidate biomarker
values, such as addition, subtraction, multiplication, or division
of the candidate biomarker values, and this will not therefore be
described in any further detail.
[0887] At step 180 it is determined if the performance value of the
combination exceeds a performance threshold, the performance
threshold being equivalent to an explained variance of at least
0.3. If so, the combination of the candidate biomarkers can be used
to define a biomarker signature. Otherwise, the previous steps can
be repeated, for example by determining alternative combinations of
the candidate biomarkers, selecting different candidate biomarkers,
or adding additional candidate biomarkers as will be described in
more detail below. In this regard, it will be appreciated that
other measures could be used, and reference to an explained
variance of at least 0.3 is intended to be a particular example for
illustrative purposes.
[0888] Accordingly, the above described method can be utilized to
select a combination of candidate biomarkers that are suitable for
use as signature biomarkers in a biomarker signature for diagnosing
the presence, absence, degree or prognosis of at least one
condition in a biological subject, for example using the method of
FIG. 1A above.
[0889] In one example, this is achieved by ensuring that at least
two of the biomarkers used are not highly mutually correlated,
thereby ensuring that each of these biomarkers contributes to the
performance of the resulting signature.
[0890] A number of further features will now be described.
[0891] In one example, the method includes determining a plurality
of measured biomarker values, each measured biomarker value being a
measured value of a corresponding biomarker of the biological
subject and applying a function to at least one of the measured
biomarker values to determine at least one derived biomarker value,
the at least one derived biomarker value being indicative of a
value of a corresponding derived biomarker.
[0892] The function used will therefore vary depending on the
preferred implementation. In one example, the function includes at
least one of multiplying two biomarker values; dividing two
biomarker values; adding two biomarker values; subtracting two
biomarker values; a weighted sum of at least two biomarker values;
a log sum of at least two biomarker values; and, a sigmoidal
function of at least two biomarker values.
[0893] More typically the function is division of two biomarker
values, so that the derived biomarker value corresponds to a ratio
of two measured biomarker values. There are a number of reasons why
the ratio might be preferred. For example, use of a ratio is
self-normalizing, meaning variations in measuring techniques will
automatically be accommodated. For example, if the input
concentration of a sample is doubled, the relative proportions of
biomarkers will remain the same. As a result, the type of function
therefore has a stable profile over a range of input
concentrations, which is important because input concentration is a
known variable for expression data. Additionally, many biomarkers
are nodes on biochemical pathways, so the ratio of biomarkers gives
information about the relative activation of one biological pathway
to another, which is a natural representation of biological change
within a system. Finally, ratios are typically easily
interpreted.
[0894] The method typically includes combining at least two
biomarker values to determine an indicator value representing the
indicator. This is usually achieved by combining at least two
biomarker values using a combining function, such as: an additive
model; a linear model; a support vector machine; a neural network
model; a random forest model; a regression model; a genetic
algorithm; an annealing algorithm; and a weighted sum.
[0895] In one example, at least one of the at least two biomarkers
is a derived biomarker and in a preferred example, the combining
function is addition of derived biomarker values that are ratios,
in which case the method includes determining first and second
derived biomarker values from ratios of first and second and third
and fourth measured biomarker values, and then adding the first and
second derived biomarker values to generate an indicator value.
[0896] In one example, the method includes determining an indicator
value, comparing the indicator value to at least one indicator
value range, and using a result of the comparison in diagnosing the
presence, absence, degree or prognosis of at least one
condition.
[0897] The above-described process is typically performed using an
electronic processing device, forming part of a processing system
such as a computer system or the like. In this case, the method
typically involves having the electronic processing device receive
a plurality of measured biomarker values, apply a function to at
least one of the measured biomarker values to determine the at
least one derived biomarker value and combining at least one
derived biomarker value and at least one other biomarker value to
determine an indicator value.
[0898] The electronic processing device can then generate a
representation in accordance with the at least one indicator value,
for example by displaying a numerical indication of the indicator
value. More typically however the electronic processing device
compares the indicator value to at least one indicator value range
and displays a result of the comparison. This can be used to
compare the indicator to defined ranges representing specific
stages, progressions or prognoses of one or more conditions,
allowing an indication of the respective stage, progression or
prognosis to be displayed.
[0899] The mutual correlation range is typically at least one of:
.+-.0.8; .+-.0.7; .+-.0.6; .+-.0.5; .+-.0.4; .+-.0.3; .+-.0.2; and
.+-.0.1. In this regard, it will be appreciated that the smaller
the mutual correlation range used, the less correlated the
biomarkers will be and hence the more useful these will be in
discriminating between the specific stages, progressions or
prognoses of one or more conditions.
[0900] It is also typical for the biomarkers used to have at least
a minimum correlation with the condition. In one example, each
biomarker has a condition correlation with the presence, absence,
degree or prognosis of the at least one condition that lies outside
a condition correlation range, the condition correlation range
being between .+-.0.3. However, it will be appreciated that the
greater the range, the greater the correlation between the
biomarker and condition, and hence the more use this will be in
performing a diagnosis. Accordingly, the condition correlation is
more typically one of: .+-.0.9; .+-.0.8; .+-.0.7; .+-.0.6; .+-.0.5;
and .+-.0.4.
[0901] Furthermore, it will be appreciated that the greater the
performance of the indicator, the greater use the indicator will be
in performing the diagnosis. Accordingly, the performance threshold
is typically indicative of an explained variance of at least one
of: 0.4; 0.5; 0.6; 0.7; 0.8; and 0.9.
[0902] As described above, the biomarker value can be of any
suitable form. However, the technique is particularly suited to
biomarker values indicative of a level or abundance of a molecule
selected from one or more of: a nucleic acid molecule; a
proteinaceous molecule; an amino acid; a carbohydrate; a lipid; a
steroid; an inorganic molecule; an ion; a drug; a chemical; a
metabolite; a toxin; a nutrient; a gas; a cell; a pathogenic
organism; and a non-pathogenic organism.
[0903] When determining biomarkers for use in a biomarker
signature, the method typically includes selecting a combining
function, determining if a performance value of a combination of
the at least two candidate biomarkers determined by the combining
function is greater than or equal to a performance threshold and if
the performance value is not greater than or equal to a performance
threshold, repeating these steps for successive different combining
functions. Thus, this allows a number of different combining
functions to be tried successively, allowing the best combining
function to be identified.
[0904] The method typically further includes selecting two
candidate biomarkers, determining if a performance value of a
combination of the two candidate biomarkers is greater than or
equal to a performance threshold and if not, combining the selected
candidate biomarkers with at least one additional candidate
biomarker before repeating the steps with at least one additional
candidate biomarker. This allows a larger number of biomarkers to
be used in the event two biomarkers are insufficient, and this can
be repeated, with increasing numbers of candidate biomarkers used
in combination and compared to the performance threshold until the
required performance is reached, or up until a defined number limit
of candidate biomarkers is reached.
[0905] To ensure the required mutual correlation is met when
selecting the candidate biomarkers, the method typically includes
selecting a highest and a next highest ranked candidate biomarker,
for the selected candidate biomarkers, determining if the mutual
correlation for the candidate biomarkers within the mutual
correlation range and if not repeating these steps until two
candidate biomarkers are selected having a mutual correlation
within the mutual correlation range. Alternatively however this can
be achieved by defining at least two groups of candidate
biomarkers, candidate biomarkers in different groups having a
mutual correlation within the mutual correlation range, ranking the
candidate biomarkers in each group and selecting candidate
biomarkers from the different groups.
[0906] In general, the candidate biomarkers are determined by using
reference data for at least one individual to define a number of
groups indicative of the presence, absence, degree or prognosis of
the at least one condition and then using at least one analysis
technique to identify a number of candidate biomarkers that are
potentially useful for distinguishing the groups. The groups can
also be used to establish a range of at least two reference
biomarker values to determine an indicator value range for the
group.
[0907] In one example, reference values measured for reference
biomarkers for the at least one individual can then be used to
identify the candidate biomarkers, for example by filtering
reference biomarkers to determine candidate biomarkers based on a
correlation of each biomarker with the condition.
[0908] In one example, the process is performed by one or more
processing systems operating as part of a distributed architecture,
an example of which will now be described with reference to FIG.
2.
[0909] In this example, the arrangement includes a number of
processing systems 201 and computer systems 203 interconnected via
one or more communications networks, such as the Internet 202,
and/or a number of local area networks (LANs) 204. It will be
appreciated that the configuration of the networks 202, 204 is for
the purpose of example only, and in practice the processing and
computer systems 201, 203 can communicate via any appropriate
mechanism, such as via wired or wireless connections, including,
but not limited to mobile networks, private networks, such as an
802.11 networks, the Internet, LANs, WANs, or the like, as well as
via direct or point-to-point connections, such as Bluetooth, or the
like.
[0910] The use of separate terms "processing system" and "computer
system" is for illustrative purposes and to enable distinction
between different devices, optionally having different
functionality. For example, the processing and computer systems
201, 203 could represent servers and clients respectively, as will
become apparent from the following description. However, this is
not intended to be limiting and in practice any suitable computer
network architecture can be used.
[0911] An example of a suitable processing system 201 is shown in
FIG. 3. In this example, the processing system 201 includes an
electronic processing device, such as at least one microprocessor
300, a memory 301, an optional input/output device 302, such as a
keyboard and/or display, and an external interface 303,
interconnected via a bus 304 as shown. In this example the external
interface 303 can be utilized for connecting the processing system
201 to peripheral devices, such as the communications networks 202,
204, databases 211, other storage devices, or the like. Although a
single external interface 303 is shown, this is for the purpose of
example only, and in practice multiple interfaces using various
methods (e.g., Ethernet, serial, USB, wireless or the like) may be
provided.
[0912] In use, the microprocessor 300 executes instructions in the
form of applications software stored in the memory 301 to perform
required processes, such as communicating with other processing or
computer systems 201, 203. Thus, actions performed by a processing
system 201 are performed by the processor 300 in accordance with
instructions stored as applications software in the memory 301
and/or input commands received via the I/O device 302, or commands
received from other processing or computer systems 201, 203. The
applications software may include one or more software modules, and
may be executed in a suitable execution environment, such as an
operating system environment, or the like.
[0913] Accordingly, it will be appreciated that the processing
systems 201 may be formed from any suitable processing system, such
as a suitably programmed computer system, PC, web server, network
server, or the like. In one particular example, the processing
systems 201 are standard processing system such as a 32-bit or
64-bit Intel Architecture based processing system, which executes
software applications stored on non-volatile (e.g., hard disk)
storage, although this is not essential. However, it will also be
understood that the processing system could be or could include any
electronic processing device such as a microprocessor, microchip
processor, logic gate configuration, firmware optionally associated
with implementing logic such as an FPGA (Field Programmable Gate
Array), or any other electronic device, system or arrangement.
[0914] As shown in FIG. 4, in one example, the computer systems 203
include an electronic processing device, such as at least one
microprocessor 400, a memory 401, an input/output device 402, such
as a keyboard and/or display, and an external interface 403,
interconnected via a bus 404 as shown. In this example the external
interface 403 can be utilized for connecting the computer system
203 to peripheral devices, such as the communications networks 202,
204, databases, other storage devices, or the like. Although a
single external interface 403 is shown, this is for the purpose of
example only, and in practice multiple interfaces using various
methods (e.g., Ethernet, serial, USB, wireless or the like) may be
provided.
[0915] In use, the microprocessor 400 executes instructions in the
form of applications software stored in the memory 401 to perform
required processes, for example to allow communication with other
processing or computer systems 201, 203. Thus, actions performed by
a processing system 203 are performed by the processor 400 in
accordance with instructions stored as applications software in the
memory 401 and/or input commands received from a user via the I/O
device 402. The applications software may include one or more
software modules, and may be executed in a suitable execution
environment, such as an operating system environment, or the
like.
[0916] Accordingly, it will be appreciated that the computer
systems 203 may be formed from any suitable processing system, such
as a suitably programmed PC, Internet terminal, lap-top, hand-held
PC, smart phone, PDA, tablet, or the like. Thus, in one example,
the processing system 300 is a standard processing system such as a
32-bit or 64-bit Intel Architecture based processing system, which
executes software applications stored on non-volatile (e.g., hard
disk) storage, although this is not essential. However, it will
also be understood that the processing systems 203 can be any
electronic processing device such as a microprocessor, microchip
processor, logic gate configuration, firmware optionally associated
with implementing logic such as an FPGA (Field Programmable Gate
Array), or any other electronic device, system or arrangement.
[0917] It will also be noted that whilst the processing and
computer systems 201, 203 are shown as single entities, it will be
appreciated that this is not essential, and instead one or more of
the processing and/or computer systems 201, 203 can be distributed
over geographically separate locations, for example by using
processing systems provided as part of a cloud based
environment.
[0918] Examples of the above-described method(s) will now be
described in further detail. For the purpose of these examples, it
is assumed that the process is performed by one or more of the
processing systems 201, acting as diagnostic servers. Interaction
by a user is via a user computer system 203, which is used to allow
a user to submit raw data, for example obtained from measurements
on a subject, with the processing system 201 generating the
indicator, allowing this to be displayed on the computer system
203.
[0919] However, it will be appreciated that the above-described
configuration assumed for the purpose of the following examples is
not essential, and numerous other configurations may be used. It
will also be appreciated that the partitioning of functionality
between the processing and computer systems 201, 203 may vary,
depending on the particular implementation.
[0920] An example of a specific method for identifying biomarkers
for using a biomarker signature will now be described with
reference to FIG. 5.
[0921] In this example, at step 500 reference data is obtained from
at least one individual. The reference data is typically in the
form of measured biomarker values obtained for at least one
individual for different stages of the at least one condition.
[0922] The reference data may be acquired in any appropriate manner
but typically this involves obtaining gene expression product data
from a plurality of individuals, selected to include individuals
diagnosed with one or more conditions of interest, as well as
healthy individuals. Detection of either types of gene expression
in use of any of the methods described herein is encompassed by the
present invention. The terms "expression" or "gene expression"
refer to production of RNA only or production of RNA and
translation of RNA into proteins or polypeptides. Thus, the term
"expression products" encompass (i) polynucleotides including RNA
transcripts and corresponding nucleic acids including complementary
cDNA copies of RNA transcripts, and (ii) polypeptides encoded by
RNA transcripts. The conditions are typically medical, veterinary
or other health status conditions and may include any illness,
disease, stages of disease, disease subtypes, severities of
disease, diseases of varying prognoses or the like. The terms
"healthy individual", "healthy subject" and the like are used
herein to refer to a subject, in particular a mammal, having no
diagnosed disease, disorder, infirmity, or ailment. The condition
of such an individual or subject is referred to herein as a
"healthy condition" such that in one example a condition can
include healthy. In specific embodiments, a healthy subject lacks
SIRS (e.g., inSIRS or ipSIRS).
[0923] In order to achieve this, gene expression product data are
collected, for example by obtaining a biological sample, such as a
peripheral blood sample, and then performing a quantification
process, such as a nucleic acid amplification process, including
PCR (Polymerase Chain Reaction) or the like, in order to assess the
activity, and in particular, level or abundance of a number of
reference biomarkers. Quantified values indicative of the relative
activity are then stored as part of the reference data.
[0924] Example reference biomarkers could include expression
products such as nucleic acid or proteinaceous molecules, as well
as other molecules relevant in making a clinical assessment. The
number of biomarkers measured for use as reference biomarkers will
vary depending upon the preferred implementation, but typically
include a large number such as, 1000, 5000, 10000 or above,
although this is not intended to be limiting.
[0925] The individuals also typically undergo a clinical assessment
allowing any conditions to be clinically identified, and with an
indication of any assessment or condition forming part of the
reference data. Whilst any conditions can be assessed, in one
example the process is utilized specifically to identify conditions
such as SIRS (Systemic Inflammatory Response Syndrome) (M S
Rangel-Frausto, D Pittet, M Costigan, T Hwang, C S Davis, and R P
Wenzel, "The Natural History of the Systemic Inflammatory Response
Syndrome (SIRS). a Prospective Study.", JAMA: the Journal of the
American Medical Association 273, no. 2 (Jan. 11, 1995): 117-123.).
SIRS is an overwhelming whole body reaction that may have an
infectious or non-infectious etiology, whereas sepsis is SIRS that
occurs during infection. Both are defined by a number of
non-specific host response parameters including changes in heart
and respiratory rate, body temperature and white cell counts
(Mitchell M Levy et al., "2001 SCCM/ESICM/ACCP/ATS/SIS
International Sepsis Definitions Conference", Critical Care
Medicine 31, no. 4 (April 2003): 1250-1256.; K Reinhart, M Bauer, N
C Riedemann, and C S Hartog, "New Approaches to Sepsis: Molecular
Diagnostics and Biomarkers", Clinical Microbiology Reviews 25, no.
4 (Oct. 3, 2012): 609-634) To differentiate these conditions they
are referred herein to as SIRS (both conditions),
infection-negative SIRS (SIRS without infection, hereafter referred
to as "inSIRS") and infection-positive SIRS (sepsis, SIRS with a
known or suspected infection, hereafter referred to as "ipSIRS")
The causes of SIRS are multiple and varied and can include, but are
not limited to, trauma, burns, pancreatitis, endotoxemia, surgery,
adverse drug reactions, and infections (local and systemic). It
will be appreciated from the following, however, that this can be
applied to a range of different conditions, and reference to SIRS
or sepsis is not intended to be limiting.
[0926] Additionally, the reference data may include additional
biomarkers such as one or more phenotypic or clinical parameters of
the individuals and/or their relatives. Phenotypic parameters can
include information such as the gender, ethnicity, age, hair color,
eye color, height, weight, waist and hip circumference, or the
like. Also, in the case of the technology being applied to
individuals other than humans, this can also include information
such as designation of a species, breed or the like. Clinical
traits may include genetic information, white blood cell count,
diastolic blood pressure and systolic blood pressure, bone density,
body-mass index, diabetes, resting heart rate, HOMA, HOMA-IR, IVGT,
resting heart rate, .beta. cell function, macrovascular function,
microvascular function, atherogenic index, low-density
lipoprotein/high-density lipoprotein ratio, intima-media thickness,
body temperature, SOFA and the like.
[0927] Accordingly, in one example the reference data can include
for each of the reference individuals information relating to at
least one and desirably to a plurality of reference biomarkers and
a presence, absence, degree or progression of a condition.
[0928] The reference data may be collected from individuals
presenting at a medical center with clinical signs relating to
relevant any conditions of interest, and may involve follow-on
consultations in order to confirm clinical assessments, as well as
to identify changes in biomarkers, and/or clinical signs, and/or
severity of clinical signs, over a period of time. In this latter
case, the reference data can include time series data indicative of
the progression of a condition, and/or the activity of the
reference biomarkers, so that the reference data for an individual
can be used to determine if the condition of the individual is
improving, worsening or static. It will also be appreciated that
the reference biomarkers are preferably substantially similar for
the individuals within the sample population, so that comparisons
of measured activities between individuals can be made.
[0929] This reference data could also be collected from a single
individual over time, for example as a condition within the
individual progresses, although more typically it would be obtained
from multiple individuals each of which has a different stage of
the one or more conditions of interest.
[0930] It will be appreciated that once collected, the reference
data can be stored in the database 211 allowing this to be
subsequently retrieved by the processing system 201 for subsequent
analysis. The processing system 201 also typically stores an
indication of an identity of each of the reference biomarkers.
[0931] In one example, the measurements are received as raw data,
which then undergoes preliminary processing. Such raw data
corresponds to information that has come from a source without
modification, such as outputs from instruments such as PCR
machines, array (e.g., microarray) scanners, sequencing machines,
clinical notes or any other biochemical, biological, observational
data, or the like. This step can be used to convert the raw data
into a format that is better suited to analysis. In one example
this is performed in order to normalize the raw data and thereby
assist in ensuring the biomarker values demonstrate consistency
even when measured using different techniques, different equipment,
or the like. Thus, the goal of normalization is to remove the
variation within the samples that is not directly attributable to
the specific analysis under consideration. For example, to remove
variances caused by differences in sample processing at different
sites. Classic examples of normalization include z-score
transformation for generic data, or popular domain specific
normalizations, such as RMA normalization for microarrays.
[0932] However, it will also be appreciated that in some
applications, such as a single sample experiment run on a single
data acquisition machine, this step may not strictly be necessary,
in which case the function can be a Null function producing an
output identical to the input.
[0933] In one example, the preferred approach is a paired function
approach over log normalized data. Log normalization is a standard
data transformation on microarray data, because the data follow a
log-normal distribution when coming off the machine. Applying a log
transform turns the data into process-friendly normal data.
[0934] At step 505 different groups are defined using the reference
data.
[0935] Prior to this occurring, the processing system 201
optionally removes a validation subgroup of individuals from the
reference data to allow the processing system 201 to determine the
candidate biomarkers using the reference data without the
validation subgroup so that the validation subgroup can be
subsequently used to validate the candidate biomarkers or
signatures including a number of the candidate biomarkers. Thus,
data from the validation subgroup is used to validate the efficacy
of the candidate or signature biomarkers in identifying the
presence, absence, degree, stage, severity, prognosis or
progression of any one or more of the conditions to ensure the
potential or signature biomarkers are effective.
[0936] In one example, this is achieved by having the processing
system 201 flag individuals within the validation subgroup or
alternatively store these in either an alternative location within
the database 211 or an alternative database to the reference data.
The validation subgroup of individuals is typically selected
randomly and may optionally be selected to include individuals
having different phenotypic traits. When a validation subgroup of
individuals is removed, the remaining individuals will simply be
referred to as reference data for ease throughout the remaining
description.
[0937] The reference data (i.e., excluding the validation subgroup)
are classified into groups. The groups may be defined in any
appropriate manner and may be defined based on any one or more of
an indication of a presence, absence, degree, stage, severity,
prognosis or progression of a condition, other tests or assays, or
measured biomarkers associated with the individuals.
[0938] For example, a first selection of groups may be to identify
one or more groups of individuals suffering from SIRS, one or more
groups of individuals suffering ipSIRS, one or more groups of
individuals suffering inSIRS, and one or more groups of healthy
individuals. Further groups may also be defined for individuals
suffering from other conditions. The groups may include overlapping
groups, so for example it may be desirable to define groups of
healthy individuals and individuals having SIRS, with further being
defined to distinguish inSIRS patients from ipSIRS patients, as
well as different degree of inSIRS or ipSIRS, with these groups
having SIRS in common, but each group of patients differing in
whether a clinician has determined the presence of an infection or
not. Additionally, further subdivision may be performed based on
phenotypic traits, so groups could be defined based on gender,
ethnicity or the like so that a plurality of groups of individuals
suffering from a condition are defined, with each group relating to
a different phenotypic trait.
[0939] It will also be appreciated, however, that identification of
different groups can be performed in other manners, for example on
the basis of particular activities of biomarkers within the
biological samples of the reference individuals, and accordingly,
reference to conditions is not intended to be limiting and other
information may be used as required.
[0940] The manner in which classification into groups is performed
may vary depending on the preferred implementation. In one example,
this can be performed automatically by the processing system 201,
for example, using unsupervised methods such as Principal
Components Analysis (PCA), or supervised methods such as k-means or
Self Organizing Map (SOM). Alternatively, this may be performed
manually by an operator by allowing the operator to review
reference data presented on a Graphical User Interface (GUI), and
define respective groups using appropriate input commands.
[0941] At step 510 biomarkers are filtered based on their ability
to distinguish between the groups. This process typically examines
the activity of the reference biomarkers for individuals within and
across the groups, to identify reference biomarkers whose
activities differ between and hence can distinguish groups. A range
of different analysis techniques can be utilized including, for
example, regression or correlation analysis techniques. Examples of
the techniques used can include established methods for
parameterized model building such as Partial Least Squares, Random
Forest or Support Vector Machines, usually coupled to a feature
reduction technique for the selection of the specific subset of the
biomarkers to be used in a signature.
[0942] Such techniques are known and described in a number of
publications. For example, the use of Partial Least Squares is
described in "Partial least squares: a versatile tool for the
analysis of high-dimensional genomic data" by Boulesteix,
Anne-Laure and Strimmer, Korbinian, from Briefings in
Bioinformatics 2007 vol 8. no. 1, pg 32-44. Support Vector machines
are described in "LIBSVM: a library for support vector machines" by
Chang, C. C. and Lin, C. J. from ACM Transactions on Intelligent
Systems and Technology (TIST), 2011 vol 2, no. 3, pg 27. Standard
Random Forest in R language is described in "Classification and
Regression by random Forest" by Liaw, A. and Wiener, M., in R news
2002, vol 2, no. 3, pg 18-22.
[0943] The analysis techniques are implemented by the processing
system 201, using applications software, which allows the
processing system 201 to perform multiple ones of the analysis
techniques in sequence. This is advantageous as the different
analysis techniques typically have different biases and can
therefore be used to identify different potential biomarkers that
can distinguish the groups, thereby reducing the risk of clinically
relevant biomarkers being overlooked.
[0944] In one example, the process involves filtering out any
biomarkers that demonstrate a correlation with the groups, and
hence with the condition, that is below a certain correlation
threshold, such as 0.3.
[0945] At step 515 derived biomarkers are generated from the
filtered reference biomarkers using one or more functions. The
nature of the derived biomarkers and the functions used will vary
depending upon the preferred implementation. For example, functions
can include division, subtraction, multiplication, addition of two
markers, sigmoidal functions applied to the product of two
biomarkers, negative logs of the division of two biomarkers,
least-squares regression applied to two vectors of markers to
produce a function (equation) output, concordance correlation
coefficient of two vectors of categorical biomarkers, or the
like.
[0946] In general, the function is selected based on a number of
rules. These rules can include: utility, functions that provide the
best results; interpretability, functions that can be understood in
terms of biological function; output, functions that produce
informative outputs; simplicity; performance assessment; least
number of biomarkers for best performance; number of biomarkers at
a statistical overfitting threshold or the like.
[0947] In one example, the preferred function is division, with the
resulting biomarkers being different ratios. It will be appreciated
that the division can be performed in multiple different ways, so
that for three biomarkers, nine different derived biomarkers can be
determined.
[0948] At step 520 a performance measure is determined for each of
the candidate biomarkers, including the filtered reference
biomarkers and any derived markers. The performance measure may be
of any suitable form and typically includes a correlation or
performance explained measure that is indicative of a correlation
of the corresponding biomarker and its ability to distinguish
between groups. In one example, the performance function used to
determine the performance measure is a standard univariate
statistical test over all candidate biomarkers. Other examples
however include a t-test, a non-parametric equivalent or area under
receiver operator curve, chi squared or regression analyses or
their equivalents, extensions or derivatives may be used.
[0949] The outcome of the applying the performance function to each
in the candidate selection step is a ranked list of biomarkers,
with the top N ranked biomarkers proceeding to the next stage. The
biomarkers falling below this threshold are no longer considered.
The threshold applied may be an absolute number or proportion of
all biomarkers, or determined by performance, such as a p value
.ltoreq.0.05. The threshold should be chosen to contain a
sufficiently large number of biomarkers to bias towards including
sufficiently independent biomarkers (i.e., low mutual
correlation).
[0950] At step 525, the processing system 201 selects a next two
candidate biomarkers based on the performance measure and on a
mutual correlation. In this regard, two markers that are highly
correlated with each other in terms of the context of the condition
will not necessarily improve the ability to distinguish a
particular presence, absence, degree or prognosis of the condition
any more than a single one of the markers. Accordingly, it is
typical to select biomarkers that have a high performance measure
in respect of the condition, but which have a mutual correlation
that falls below a mutual correlation threshold. The mutual
correlation threshold used will vary depending upon the preferred
implementation, and is typically selected to be as low as possible,
as described above. Examples of the manner in which the biomarkers
are selected will be described in more detail below with respect to
FIGS. 6A and 6B.
[0951] At step 530, the processing system 201 determines a
performance of a next candidate biomarker combination. In this
regard, the processing system 201 will use a combining function
such as addition, to combine the biomarker values of the selected
candidate biomarkers and use this to determine and indicator value
based on the combination of biomarker values. The performance can
be determined in any suitable manner, such as using statistical
measurements, correlation measurements, concordance measurements or
aggregate performance measurements such as averages. In one
particular example, the performance measure is a `variance
explained` (VE). A VE of "1" means that using the biomarkers, you
can perfectly classify/predict the disease. A VE of "0.8" means
that your markers account for 80% of the result in practice.
[0952] Accordingly, at step 535 the processing system 201 compares
the performance of the indicator to a performance threshold and
determines if this is exceeded at step 540. In the event that the
threshold is exceeded, this indicates that the selected combination
of markers provides the required degree of discrimination allowing
the presence, absence, degree or prognosis of the condition to be
determined.
[0953] In the event that the threshold is not exceeded at step 540,
it is determined if all combinations have been considered at step
545. In this regard, it is possible that multiple different
combinations of the two selected biomarkers to be tried, so if each
possible combination has not been considered, the processing system
201 returns to step 530 to determine the performance of a next
candidate biomarker combination. In this regard, the combinations
used will typically be ordered in terms of preference, so that
preferred combinations are tried first, with less preferred
combinations being tried only in the event that preferred
combinations prove unsuccessful.
[0954] Once all candidate biomarker combinations have been
considered for the two candidate biomarkers selected, and if the
performance threshold has still not been exceeded, the process
moves onto step 550 to compare the current number of candidate
biomarkers being considered to a limit. In this regard, the limit
is used to control the overall number of biomarkers in the
biomarker signature, thereby minimizing signature size and hence
the cost of performing the associated measurements and
diagnosis.
[0955] If the limit has not been exceeded an additional biomarker
is added based on the correlation and performance at step 560, with
the process moving onto step 530 to determine a performance of the
next candidate biomarker combination. Otherwise if a limit has been
reached, then an alternative next two candidate biomarkers are
selected at step 525. Thus, this process allows additional
candidate biomarkers to be progressively included, with a
combination of the multiple candidate biomarkers being compared to
the performance threshold, to determine if the required performance
is met. If this is not achieved before the number of candidate
biomarkers reaches the limit, the process is recommenced using two
different candidate biomarkers.
[0956] Once the performance threshold has been exceeded at step
540, the selected candidate biomarkers can be defined as signature
biomarkers for inclusion in a biomarker signature for the one or
more conditions at step 565.
[0957] It should be noted that before the biomarker signature is
finalized at step 565, additional checks might be performed, to
ensure that the candidate biomarkers included in the signature
should not be excluded for any reason. For example, candidate
biomarkers might be excluded for cost considerations as some
combinations of candidate biomarkers may cost more than others. For
example, a larger number of biomarkers may cost more than a smaller
number, and the additional cost may not be justified by a small
improvement in performance. Alternatively, the cost might be
increased if multiple different tests are required in order to
measure required biomarker values.
[0958] Biomarkers might also be excluded from use for legal
reasons, for example if their use is restricted for approval or
intellectual property reasons. Some biomarkers may be difficult to
measure from a technical perspective, for example very low
expression in vivo, which increases variability and therefore
reduces robustness.
[0959] The performance of each biomarker combination panel may also
include some variability, typically expressed as confidence
intervals around the reported performance. Although a point
estimate for one panel may be higher than for another, if the
difference given the variability is not significant, the
combinations may be considered equivalent.
[0960] Once a particular combination of signature biomarkers has
been defined, at step 570 the processing system 201 can determine
an indicator value range associated with each group. In particular,
the range of reference biomarker values for the signature
biomarkers within each group are used to calculate indicator value
ranges for each group. These can then be compared to an indicator
value calculated for a biological subject having an unknown
presence absence, degree or progression of the at least one
condition and used to identify a group to which the subject would
belong and hence the presence, absence, degree or progression of
the condition.
[0961] Thus, the above-described process iteratively assesses the
biomarkers, initially selecting two biomarkers, with various
combinations of these being considered to determine if these have
the required performance for use in diagnosing the presence,
absence, degree or progression of a condition. In the event that
the required performance is not provided, additional biomarkers can
be added and further combinations tried. Thus the process can
consider three biomarkers, four biomarkers, five biomarkers, six
biomarkers, seven biomarkers, eight biomarkers, nine biomarkers or
more. Typically this is performed to a limit which may be defined
based for example on the number of biomarkers that can practically
be measured within given cost or process parameters. In the event
that the required performance is not obtained the process moves
onto to select alternative candidate biomarkers with this being
repeated.
[0962] Thus it will be appreciated that the above process initially
selects those biomarkers which have the suitable performance and
which are not highly correlated on the basis that these provide the
maximum performance. The ability of these biomarkers to distinguish
is then tested and in the event that this is insufficient, further
biomarkers can be added to a limit. If this still does not provide
the required discriminatory performance alternative biomarkers can
be selected.
[0963] The process of selecting two candidate biomarkers at step
525 can be achieved in any number of ways depending upon the
preferred implementation and examples of this will now be described
with reference to FIGS. 6A and 6B.
[0964] In the example of FIG. 6A, at step 600 biomarkers are
grouped according to their mutual similarity. Thus, highly
correlated biomarkers are put together in common groups. Biomarkers
within the group are ranked at step 610 based on their performance
measure in terms of their correlation with the condition, with the
highest ranked biomarkers from two of the groups being selected at
step 620 to define the next two candidate biomarkers. It will be
appreciated if additional candidate biomarkers are required, these
can be selected from different groups to the first two candidate
biomarkers.
[0965] An alternative process is shown in FIG. 6B. In this example,
at step 650 biomarkers are ranked based on their performance at
discriminating the condition(s). At step 660 a next highest
biomarker is selected, with the remaining biomarkers being
re-ranked on the combination of their similarity with the selected
biomarker, for example using mutual information, as well as their
performance. The next highest biomarker is then selected at step
680 with this process being repeated as required.
[0966] Accordingly, it will be appreciated that the above-described
processes provide mechanisms for selecting a combination of
biomarkers, and more typically derived biomarkers, that can be used
to form a biomarker signature, which in turn can be used in
diagnosing the presence, absence or degree of at least one
condition or in providing a prognosis of at least one condition. In
this regard, the biomarker signature defines the biomarkers that
should be measured (i.e., the signature biomarkers), how derived
biomarker values should be determined for measured biomarker
values, and then how biomarker values should be subsequently
combined to generate an indicator value. The biomarker signature
can also specify defined indicator value ranges that indicate a
particular presence, absence, degree or prognosis of one or more
conditions.
[0967] An example of the method of using a biomarker signature
described above will now be described with reference to FIG. 7.
[0968] In this example, at step 700 a plurality of measured
biomarker values are measured for a biological subject whose
condition is unknown, with these typically being provided to the
processing system 201, for example by download from measuring
equipment or the like.
[0969] After any required processing, such as normalization or the
like, at step 710, the processing system 201 applies one or more
functions to the measured biomarker values to determine any
required derived biomarker values. A derived biomarker value and
another biomarker value (i.e., another derived biomarker value or a
measured biomarker value) are combined to generate an indicator
value, which can then be displayed or otherwise used in determining
the presence, absence, degree or prognosis of one or more
conditions. Thus, this can involve simply displaying the indicator
value, allowing an assessment to be made by a medical practitioner
or alternatively may involve further processing, such as comparing
the indicator to defined indicator value ranges that indicate a
particular presence, absence, degree or prognosis of one or more
conditions, with the results of the comparison being displayed.
[0970] Accordingly, in the above-described method the biomarker
signature defines the biomarker values that need to be measured
and/or derived, allowing the processing system 201 to automatically
generate an indicator value based on received measured biomarker
values. Once this has been completed, the processing system 201 can
compare the indicator value to the indicator value ranges, and
either display results of the comparison, or alternative interpret
the results of the comparison, allowing an indicator to be
displayed that is indicative of the presence, absence, degree or
prognosis of a condition. This can then be used by a medical
practitioner as required in performing a medical diagnosis of the
biological subject.
[0971] Using the above-described methods it has been identified
that the use of ratios of "immune system biomarkers" is
particularly beneficial when assessing a likelihood of a biological
subject having a presence, absence, degree or prognosis of at least
one medical condition.
[0972] As used herein, the term "immune system biomarker" refers to
a biomarker of the host's immune system that is altered, or whose
level of expression is altered, as part of an inflammatory response
to damage or pathogenic insult, including metabolic, toxic,
neurotoxic, iatrogenic, thermal or chemical insults, illustrative
examples of which include trauma, surgery, drugs including
chemotherapeutic drugs, radiation, disease including pathogenic
infection, metabolic disease and ischemia, as well as foreign or
implanted substances.
[0973] The term "immune system", as used herein, refers to cells,
molecular components and mechanisms, including antigen-specific and
non-specific categories of the adaptive and innate immune systems,
respectively, that provide a defense against damage and insults and
matter, the latter comprised of antigenic molecules, including but
not limited to tumors, pathogens, and self-reactive cells.
[0974] The term "innate immune system" refers to a host's
non-specific reaction to insult to include antigen-nonspecific
defense cells, molecular components and mechanisms that come into
action immediately or within several hours after exposure to almost
any insult or antigen. Elements of the innate immunity include for
example phagocytic cells (monocytes, macrophages, dendritic cells,
polymorphonuclear leukocytes such as neutrophils,
reticuloendothelial cells such as Kupffer cells, and microglia),
cells that release inflammatory mediators (basophils, mast cells
and eosinophils), natural killer cells (NK cells) and physical
barriers and molecules such as keratin, mucous, secretions,
complement proteins, immunoglobulin M (IgM), acute phase proteins,
fibrinogen and molecules of the clotting cascade, and cytokines.
Effector compounds of the innate immune system include chemicals
such as lysozymes, IgM, mucous and chemoattractants (e.g.,
cytokines or histamine), complement and clotting proteins.
[0975] The term "adaptive immune system" refers to antigen-specific
cells, molecular components and mechanisms that emerge over several
days, and react with and remove a specific antigen. The adaptive
immune system develops throughout a host's lifetime. The adaptive
immune system is based on leukocytes, and is divided into two major
sections: the humoral immune system, which acts mainly via
immunoglobulins produced by B cells, and the cell-mediated immune
system, which functions mainly via T cells.
[0976] Accordingly, in one example, an indicator is determined that
correlates to a ratio of immune system biomarkers, which can be
used in assessing a likelihood of a biological subject having a
presence, absence, degree or prognosis of at least one medical
condition.
[0977] In this example, the method includes determining a pair of
biomarker values, each biomarker value being a value measured or
derived for at least one corresponding immune system biomarker of
the biological subject and being at least partially indicative of a
concentration of the immune system biomarker in a sample taken from
the subject.
[0978] The biomarker values are used to determine a derived
biomarker value using the pair of biomarker values, the derived
biomarker value being indicative of a ratio of concentrations of
the pair of immune system biomarkers.
[0979] Thus, if the biomarker values are the concentrations of the
biomarkers, then the derived biomarker value will be based on a
ratio of the biomarker values. However, if the biomarker values are
related to the concentrations of the biomarkers, for example if
they are logarithmically related by virtue of the biomarker values
being based on PCR cycle times, or the like, then the biomarker
values may be combined in some other manner, such as by subtracting
the cycle times to determine a derived biomarker value indicative
of a ratio of the concentrations.
[0980] The derived biomarker is then used to determine the
indicator, either by using the derived biomarker value as an
indicator value, or by performing additional processing, such as
comparing the derived biomarker value to a reference or the like,
as will be described in more detail below.
[0981] In any event, combining biomarker values to determine a
ratio of concentrations of immune system biomarkers, and then using
this to determine an indicator allows indicators to be determined
for use in determining a likelihood of a subject suffering from a
range of different conditions, depending on the immune system
biomarkers selected, which as it will be appreciated can be
performed using the above described process.
[0982] A number of further features will now be described.
[0983] In one example, the process involves determining a first
derived biomarker value using a first pair of biomarker values, the
first derived biomarker value being indicative of a ratio of
concentrations of first and second immune system biomarkers,
determining a second derived biomarker value using a second pair of
biomarker values, the second derived biomarker value being
indicative of a ratio of concentrations of third and fourth immune
system biomarkers and determining the indicator by combining the
first and second derived biomarker values. Thus, in this example,
two pairs of derived biomarker values can be used, which can assist
in increasing the ability of the indicator to reliably determine
the likelihood of a subject having a condition.
[0984] The derived biomarker values could be combined using a
combining function such as an additive model; a linear model; a
support vector machine; a neural network model; a random forest
model; a regression model; a genetic algorithm; an annealing
algorithm; a weighted sum; a nearest neighbor model; and a
probabilistic model.
[0985] In one example, the indicator is compared to an indicator
reference, with a likelihood being determined in accordance with
results of the comparison. The indicator reference is typically
derived from indicators determined for a number of individuals in a
reference population. The reference population typically includes
individuals having different characteristics, such as a plurality
of individuals of different sexes; and/or ethnicities, with
different groups being defined based on different characteristics,
with the subject's indicator being compared to indicator references
derived from individuals with similar characteristics. The
reference population can also include a plurality of healthy
individuals, a plurality of individuals suffering from at least one
diagnosed medical condition, a plurality of individuals showing
clinical signs of at least one medical condition and/or first and
second groups of individuals, each group of individuals suffering
from a respective diagnosed medical condition.
[0986] It will be appreciated that the individuals selected will
depend on the intended use of the indicator. In particular, when
the indicator is for use in determining the likelihood that a
biological subject has a specific medical condition, the sample
population includes individuals presenting with clinical signs of
the specific medical condition, individuals diagnosed with the
specific medical condition and healthy individuals. This ensures
that the assessment of indicator validity applies regardless of not
or whether the individual has the specific condition or not.
[0987] It will also be appreciated that the sample population could
also include a plurality of individuals of different sexes,
ethnicities, ages, or the like, allowing the control value ranges
to be common across populations. However, this is not essential,
and alternatively control value thresholds could be established
that are specific to a particular sub-set of the population. In
this case, it would be necessary to ensure that the control value
threshold ranges used are appropriate for the subject under
consideration.
[0988] The indicator can also be used for determining a likelihood
of the subject having a first or second condition, in other words
to distinguish between the conditions. In this case, this would
typically be achieved by comparing the indicator to first and
second indicator references, the first and second indicator
references being indicative of first and second conditions and
determining the likelihood in accordance with the results of the
comparison. In particular, this can include determining first and
second indicator probabilities using the results of the comparisons
and combining the first and second indicator probabilities, for
example using a Bayes method, to determine a condition probability
corresponding to the likelihood of the subject having one of the
conditions. In this situation the first and second conditions could
include two medical conditions, or a single medical condition and a
healthy condition.
[0989] In this case, the first and second indicator references are
distributions of indicators determined for first and second groups
of a reference population, the first and second group consisting of
individuals diagnosed with the first or second condition
respectively. In this regard, this can be achieved by determining
first and second groups of individuals, each group of individuals
having a presence or absence of a diagnosed medical condition and
determining first and second indicator references for the first and
second groups respectively. This allows the indicator to be used to
distinguish between first and second conditions, which could
include different medical conditions, as well as healthy
conditions. It will also be appreciated that whilst two groups are
described, this is not essential and three or more groups could
also be defined.
[0990] The process is usually performed using at least one
electronic processing device, such as a suitably programmed
computer system or the like.
[0991] In this case, the electronic processing device typically
obtains at least two pairs of measured biomarker values, either by
receiving these from a measuring or other quantifying device, or by
retrieving these from a database or the like. The processing device
then determines a first derived biomarker value indicative of a
ratio of concentrations of first and second immune system
biomarkers and a second derived biomarker value indicative of a
ratio of third and fourth immune system biomarkers. The processing
device then determines the indicator by combining the first and
second derived biomarker values.
[0992] The processing device can then generate a representation of
the indicator, for example by generating an alphanumeric indication
of the indicator, a graphical indication of a comparison of the
indicator to one or more indicator references or an alphanumeric
indication of a likelihood of the subject having at least one
medical condition.
[0993] The method would also typically include obtaining a sample
taken from the biological subject, the sample including
polynucleotide expression products and quantifying at least some of
the polynucleotide expression products within the sample to
determine the pair of biomarker values. This can be achieved using
any suitable technique, and will depend on the nature of the immune
system biomarkers.
[0994] For example, if the indicator is based on a ratio of
concentrations of the polynucleotide expression products, this
process would typically include quantifying polynucleotide
expression products by amplifying at least some polynucleotide
expression products in the sample, determining an amplification
amount representing a degree of amplification required to obtain a
defined level of each of a pair of polynucleotide expression
products and determining the indicator by determining a difference
between the amplification amounts. In this regard, the
amplification amount is generally a cycle time, a number of cycles,
a cycle threshold and an amplification time.
[0995] In this case, the method includes determining a first
derived biomarker value by determining a difference between the
amplification amounts of a first pair of polynucleotide expression
products, determining a second derived biomarker value by
determining a difference between the amplification amounts of a
second pair of polynucleotide expression products and determining
the indicator by adding the first and second derived biomarker
values.
[0996] As previously discussed, the at least two immune system
biomarkers have a mutual correlation in respect of the at least one
condition that lies within a mutual correlation range, the mutual
correlation range being between .+-.0.9 and the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence, degree or prognosis of the at least one condition, the
performance threshold being indicative of an explained variance of
at least 0.3.
[0997] Typically the mutual correlation range is one of .+-.0.8;
.+-.0.7; .+-.0.6; .+-.0.5; .+-.0.4; .+-.0.3; .+-.0.2; and,
.+-.0.1.
[0998] Typically each immune system biomarker has a condition
correlation with the presence, absence, degree or prognosis of the
at least one condition that lies outside a condition correlation
range, the condition correlation range being between .+-.0.3 and
more typically .+-.0.9; .+-.0.8; .+-.0.7; .+-.0.6; .+-.0.5; and,
.+-.0.4. Typically the performance threshold is indicative of an
explained variance of at least one of 0.4; 0.5; 0.6; 0.7; 0.8; and,
0.9.
[0999] The above-described method has been used to identify 1650
biomarkers of inflammatory response syndromes (also referred to
interchangeably herein as "IRS biomarkers" or "IRS immune system
biomarkers"), which are useful for assisting in distinguishing: (1)
between SIRS affected subjects (i.e., subjects having inSIRS or
ipSIRS) and healthy subjects or subjects not affected by SIRS; (2)
between subjects with inSIRS and subjects with ipSIRS; and/or (3)
between subjects with different stages of ipSIRS (e.g., sepsis,
severe sepsis and septic shock). Based on this identification, the
present inventors have developed various methods, compositions,
apparatus and kits, which take advantage of these biomarkers to
provide an indicator for use in diagnosing the presence, absence or
degree of at least one condition, or for prognosing at least one
condition, wherein the at least one condition is selected from a
healthy condition (e.g., a normal condition or one in which inSIRS
and inSIRS are absent), inSIRS, ipSIRS, or a stage of ipSIRS (e.g.,
a stage of ipSIRS with a particular severity, illustrative examples
of which include mild sepsis, severe sepsis and septic shock). In
advantageous embodiments, the methods and kits involve monitoring
the expression of IRS biomarker genes in cells of the immune
systems, including blood cells (e g., immune cells such as
leukocytes), which may be reflected in changing patterns of RNA
levels or protein production that correlate for example with the
presence of active disease or response to disease.
[1000] The IRS biomarkers are expression products of genes (also
referred to interchangeably herein as "IRS biomarker genes" or IRS
immune system biomarker genes"), including polynucleotide and
polypeptide expression products. As used herein, polynucleotide
expression products of IRS biomarker genes are referred to herein
as "IRS biomarker polynucleotides." Polypeptide expression products
of the IRS biomarker genes are referred to herein as "IRS biomarker
polypeptides." The term "gene", as used herein, refers to a stretch
of nucleic acid that codes for a polypeptide or for an RNA chain
that has a function. While it is the exon region of a gene that is
transcribed to form RNA (e.g., mRNA), the term "gene" also includes
regulatory regions such as promoters and enhancers that govern
expression of the exon region.
[1001] Suitably, the IRS biomarker genes are selected from the
group consisting of: PRKCZ, SKI, RER1, TAS1R1, VAMP3, AGTRAP,
VPS13D, KLHDC7A, NBLH/Clorf151, MDS2, RCAN3, LDLRAP1, MAN1C1,
SH3BGRL3, DHDDS, HCRTR1, CCDC28B, LCK, ZNF362, THRAP3,
PPIE//CCDC25, CAP1, CTPS, Clorf84, FAAH, DMBX1, CYP4B1, BTF3L4,
LRRC42, Clorf175//TTC4, TMEM61, FPGT//TNNI3K, ACADM, SPATA1, EPHX4,
RPAP2, RPL5//SNORA66//SNORD21//FAM69A, RTCD1, SLC30A7,
RNPC3//AMY2B, CELSR2, AHCYL1, CEPT1//DRAM2, CHIA, LIX1L, UPF0627,
MRPS21, TNFAIP8L2, SMCP, DCST1, RAG1AP1, Clorf182, HAPLN2, NTRK1,
CD1E, TOMM40L//NR1I3, POU2F1, TIPRL, SFT2D2, CACNA1E, SMG7, OCLM,
RGS2, ZC3H11A//RP11-74E24.2, MFSD4, IL20, RPS6KC1, C1orf95, ARF1,
GALNT2, TNFRSF4, NADK, FLJ14100//C1orf86, GPR153, RERE, SLC2A7,
SDHB, RNF186, DDOST, GPN2, RPA2, PEF1, PTP4A2, TRIM62, PHC2, LSM10,
MRPS15, RRAGC, COL9A2, TESK2, NRD1, KTI12, CC2D1B, YIPF1, JAK1,
SLC35D1, DIRAS3, ZZZ3, GNG5, ZNHIT6, ODF2L, SEP15, BARHL2, GCLM,
CLCCH/GPSM2//Clorf62, SORT1, SLC16A4, PHTF1, RSBN1, DENND2C//BCAS2,
CD58, SPAG17//WDR3, REG4//NBPF7,
RP11-94I2.2//NBPF16//NBPF11//NBPF15//NBPF8//NBPF20//NBPF10//NBPF14//NBPF1-
//LOC100288142//NBPF12//KIAA1245//LOC100290137, APH1A, POGZ, TDRKH,
THEM4, S100A11, CRNN, SPRR2C, S100A12, S100A8, GATAD2B//PLIN2,
DENND4B, PBXIP1, PYGO2, SHC1, DCST2, GBA//GBAP, ASH1L, RITZ, MEF2D,
AIM2, COPA, DEDD, TADA1L, GPA33, CD247, F5, PIGC, KIAA0040,
TOR1AIP2//TOR1AIP1//IFRG15, STX6//KIAA1614, EDEM3, UCHL5, DENND1B,
DDX59, KIF21B, ARL8A, CYB5R1, MYBPH, CHI3L1, PIK3C2B//LOC100130573,
NUAK2, NUCKS1, FAIM3, PLXNA2, SLC30A1, LPGAT1, ANGEL2,
RAB3GAP2//AURKAPSH/AURKA//SNORA36B, TP53BP2, NVL, TMEM63A, PARP1,
ITPKB, TARBP1, CHML, AKT3, SMYD3, AHCTF1, OR1C1, NCOA1, HADHB,
ABHD1//PREB, SPAST, SLC30A6//DDX50, CRIPT, MSH2, FOXN2, CCDC104,
VRK2, AHSA2//USP34, OTX1, AFTPH, CEP68, PLEK, ANXA4, MXD1, NAGK,
SMYD5//NOTO, MTHFD2, TTC31, SEMA4F, TMSB10, SH2D6, GNLY, KCNIP3,
CNNM4, CNNM3, ZAP70, LIP T1//MRPL30, MAP4K4, IL1R2, IL1R1, IL18R1,
POLR1B, CHCHD5, IL1RN, PSD4, DDX18, INSIG2, TMEM177//LOC100125918,
RALB, PROC, GPR17//LOC100291428//LIMS2, IMP4, FAM123C, ACVR2A,
MBD5, LYPD6B, SLC4A10, UBR3, HAT1, ITGA6, ZAK, OSBPL6, PLEKHA3,
ZC3H15, COL3A1, GLS, OBFC2A, COQ10B, MARS2, CFLAR, NOP58, FAM117B,
CYP20A1, FASTKD2, PIKFYVE, C2orf62, SLC11A1, AGFG1, CHRNG, EIF4E2,
TRPM8, LRRFIP1, GAL3ST2, TMEM18, LAPTM4A, SF3B14, TP53I3, UNQ2999,
GPR113//SELI, MPV17, PPM1G, NLRC4, CDC42EP3, HNRPLL, COX7A2L,
KCNG3, CALM2//C2orf61, BCL11A, XPO1, NAT8B, DUSP11, MOGS, SNRNP200,
SEMA4C, MITD1, ILIA, SLC35F5, CCDC93, CLASP1, SAP130, YSK4, GTDC1,
ORC4L, NR4A2//FLJ46875, DPP4, GALNT3, SCN7A, FRZB, STK17B,
CLKH/PPIL3, MPP4, INO80D, KLF7, FAM119A, NGEF, ARL4C, RAB17, HDLBP,
LRRN1, SETD5, IRAK2, C3orf42, TSEN2, NR2C2//MRPS25, UBE2E1,
C3orf35, SNRK, ZNF197, GNAI2, ALAS1, PRKCD, CACNA1D, PXK, PTPRG,
ATXN7, SLC35A5, SLC15A2, CCDC48, DNAJC13, CLDN18, GYG1, SELT,
MED12L, RAP2B, MYNN, ABCF3, VPS8, HRG, EIF4A2//SNORA4, LPP, CCDC50,
LOC152217, TADA3L, SEC13, TIMP4, METTLE, DAZL//DAZ4//DAZ3//DAZ2,
SATB1//TBC1D5, SCN10A, SEC22C, ZDHHC3, ZDHHC3, SLC6A20, UQCRC1,
PRKAR2A, IMPDH2, CCDC71, UBA7, CAMKV, WDR82, LMOD3, FOXP1, MORC1,
ATG3, GSK3B//LOC100129275, HCL51, KPNA1, PTPLB, C3orf22, RPN1,
KIAA1257//ACAD9//LOC100132731, FOXL2, MECOM, PLD1, GNB4, MRPL47,
KLHL6, THPO, ETV5, BCL6//LOC100131635, ATP13A5, TMEM44, KIAA1530,
TACC3, CNO, BST1, KLF3, TMEM33//DCAF4L1, KIT, ENAM, FAM47E//STBD1,
ENOPH1, PDLIM5, CCDC109B//HIGD1A//CCDC13, EGF, PCDH10, RAB33B,
TMEM184C, RBM46, GRIA2, C4orf39, KLHL2, TLL1, F11, SLBP,
HAUS3//POLN, PPARGC1A, TLR10, C4orf34, TXK, RPL21P44, KDR, RCHY1,
CNOT6L, PLACE, HPSE, GPRIN3, PPA2, COL25A1, C4orf3, QRFPR, MFSD8,
MAP9, PDGFC, TKTL2, ACSL1, SUBH/TMEM183A, CARD6, MCCC2, TNPO1,
PDE8B, PAPD4, THBS4, FAM151B, RASGRF2, SNX2, LMNB1//PCIF1, MEGF10,
LEAP2, TCF7, KDM3B, CXXC5, SLC4A9,
ANKHD1-EIF4EBP3//ANKHD1//EIF4EBP3, KIAA0141, GRPEL2, MFAP3, GABRA6,
GABRA1, DOCK2, RANBP17//USP12, ERGIC1, ATP6V0E1//SNORA74B, ZNF346,
NSD1, CLPTM1L, UGT3A1, GDNF, TTC33, hCG.sub.--2039148, MOCS2,
SLC38A9, CCDC125, ANKRA2, HAPLN1, CCNH, TMEM161B, MBLAC2, MCTP1,
TICAM2//TMED7//TMED7-TICAM2, KIF3A, C5orf15, SKP1, CXCL14, KLHL3,
CD14, YIPF5, LARS, DCTN4, CCDC69, ATOX1, TIMD4, ADAM19, SLIT3,
RNF44, DOK3, MGAT4B//SQSTM1, C5orf45//SQSTM1, RASGEF1C, MGAT1,
IRF4, HIVEP1, E2F3, HIST1H4I, HIST1H2BM, MOG, ZNRD1//NCRNA00171,
TRIM15, HCG27, BAT2//SNORA38, CYP21A2, ITPR3, MAPK14, MAPK13,
PNPLA1, SFRS3, CDKN1A, FOXP4, CUL9, RUNX2, ZNF451, SOBP, C6orf182,
KIAA1919, RWDD1, KPNA5, TPD52L1, ARG1, RAB32, ARID1B, SLC22A3,
SERPINB1, C6orf146, GCM2, ATXN1, DCDC2//KAAG1, HIST1H3I, HIST1H4L,
GABBR1, RNA243, DDAH2, CLIC1, NEU1, RXRB, VPS52, TCP11, CLPS, PGC,
ZNF318, YIPF3, MRPL14, PLA2G7, PKHD1, IL17F, HTR1B, GABRR2, UBE2J1,
BACH2, MCM9, VNN1, IL20RA, FLJ27255, T, RPS6KA2, HGC6.3,
UNC84A//C7orf20, SDK1, ZDHHC4, C7orf26, GLCCI1thcag7.903, GPNMB,
CCDC126, WIPF3//ZNRF2//LOC441208, GPR141, STARD3NL, POU6F2, CDC2L5,
ZMIZ2, UPP1, ZNF273, KCTD7//RABGEF1,
RABGEF1thcag7.967//tcag7.951//KCTD7//LOC100293333, CCDC132,
PVRIG//PILRB//STAG3, PILRB//PVRIG//STAG3, C7orf51, GNB2, LRRC17,
LRRN3, CFTR, LSM8, LUC7L2, MGAM//LOC100124692, GIMAP7, INSIG1,
RBM33, ICA1, FAM126A, HIBADH, TRIL, SCRN1, ELM01, INHBA, CAMK2B,
NPC1L1, DDC//LOC100129427, NSUN5//NSUN5B//NSUN5C, CLDN3,
C7orf23//DMTF1, SRI, BET1, MCMI, GATS, ATXN7L1//RINT1//EFCAB10,
KIAA1549, SLC37A3, SMARCD3, MLL3//BAGE2, CLN8, MSRA, PIWIL2,
NEFM//LOC100129717, EPHX2, LEPROTL1, MAK16//C8orf41, AP3M2, FNTA,
SGK196, UBE2V2, FLJ46365, SNTG1, TRIM55, C8orf45, PREX2, PLEKHF2,
BAALC//FLJ10489, TTC35, MTBP, ZHX2, RNF139, TG, DENND3//C8orf60,
TNFRSF10D, TRIM35, GSR, WHSC1L1, PCMTDJ//PXDNL, NCOA2,
TRAMMLOC286190, RUNX1T1, EXT1, DDEF1IT1, CDC37L1, UBE2R2,
UBAP1//KIF24, GALT, RGP1//GBA2, TGFBR1, C9orf6//IKBKAP,
IMAGE5303689, ATP6V1G1, TLR4, SET, MRPL41, C9orf68, HAUS6//SCARNA8,
KLHL9, C9orf82, NDUFB6//DFFB, SIT1, FAM108B1, TRPM6, FRMD3,
SLC28A3, BICD2, C9orf84, AKNA, MEGF9, C5, GOLGA1//SCAI, SH2D3C,
FAM102A, FLJ10232, ASB6, BAT2L, EDF1, FBXW5, C10orf18, FBXO18,
GATA3, CUGBP2, VIM, STAM, WAC, BAMBI, ZNF487//LOC439911, ALOX5,
WDFY4, SRGN, CCDC109A, FAM149B1//FAM149B2, MINPP1, PTEN//PTENP1,
ENTPD1//C10orf131, ABCC2, SFXN2, SHOC2, ACSL5, BCCIP//DHX32,
FAM188A, CUBN, SVIL//hCG1783494, FAM13C//PHYHIPL, ATAD1, ANKRD22,
FLJ34077, COX15, ERLIN1, ACTR1A, ABLIM1, RAB11FIP2, C10orf84,
PRDX3, C10orf119, NSMCE4A, TALDOMINTS8, TNNT3, FXC1, PDE3B,
DNAJC24, PTPRJ//OR4B1, C11orf31, TMEM109, CD6, CDS, TMEM138,
POLR2G, TMEM179B, NAT11, OTUB1, RBM14//RBM4, AIP, PPFIA1,
IL18BP//NUMA1, C11orf30, C11orf82, TMEM126B, C11orf73, PIWIL4,
LOC100132686, PAFAH1B2, UBE4A, TRAPPC4, SC5DL, VWA5A//OR10D1P,
STT3A, VPS26B, TRIM21, ZBED5, SAAL1, FANCF, LIN7C, PHF21A, CUGBP1,
OSBP, CYBASC3, TUT1, SLC25A45, LTBP3, EIF1AD, GAB2, CREBZF, PICALM,
SLC36A4, CCDC82, KIAA1826, MPZL3, MPZL2, H2AFX, SIAE, ZBTB44, HSN2,
ADIPOR2, NCAPD2//SCARNA10//FADS1, PTPN6, CLEC4D, CDKN1B, GOLT1B,
FAR2, FGD4, TMEM106C, TMBIM6, C12orf62, PRR13//PCBP2, DGKA, COQ10A,
TSPAN31, CDK4/MARCH9/C3HC4, LEMD3, IRAK3, TMTC3, ACTR6, TCTN1,
PXMP2//PGAM5, DCP1B, SLC2A3//SLC2A14, C3AR1, PLBD1, TM7SF3,
ASB8//PHB, LMBR1L, FMNL3//PRPF40B, AAAS, NFE2, GPR84, CD63,
SARNP//DNAJC14, NACA, CDK4//TSPAN31, TMBIM4//LOC100133322, IL22,
LIN7A, HAL, APPL2, GLTP, GIT2, VPS29, PPTC7, DDX54//CCDC42B,
SLC24A6, SDS, RBM19, MED13L, C12orf49, FBXO21, WSB2, TAOK3, CIT,
RAB35, RPLP0, PXN, TRIAP1, SFRS9, POPS, UNQ1887, C12orf43, ANAPC5,
KDM2B, MORN3, TMEM120B//RHOF, LOC338799, DIABLO//B3GNT4, VPS33A,
CLIP1, PITPNM2, EIF2B1, CCDC92, NCOR2, DHX37, DDX51, POLE, GOLGA3,
ZMYM2, SPATA13//C1QTNF9, NUPL1, PAN3//EEF1A1//CHCHD2, ALOX5AP,
EEF1DP3, KL, UFM1, NARG1L, ITM2B, FNDC3A, CDADC1, ARL11, LMO7,
DNAJC3, TM9SF2, CLYBL, PCCA, ABHD13, LAMP1, TMCO3, UPF3A,
ZMYM5//ZMYM2, ZDHHC20//LOC728099, PARP4, MTMR6//LOC646482, HSPH1,
N4BP2L2//CG030, ELFT, LCP1, KPNA3, C13orf1, DLEU2//DLEU2L, GUCY1B2,
INTS6, DACH1, TBC1D4, EDNRB, UGGT2, GPR183, LIG4, ANKRD10, RASA3,
RNASE2//LOC6433 32, RPGRIP1, IRF9, TSSK4, C14orf21, SCFD1, FANCM,
ABHD12B, PTGDR, FBXO34//KIAA0831, C14orf101, ACTR10, ARID4A, JKAMP,
HIF1A, SYNE2, EXD2, SLC39A9, SFRS5, PCNX,
SIPA1L1//SNORD56B//LOC145474//LOC283567, YLPM1, BATF,
FLVCR2//RPS24, GPR65, TDP1, EVL, ZNF839, TDRD9, INF2, PLD4,
MTA1//LOC647310//LOC100128343, NDRG2, DAD1//OR6J1, SLC7A8, IPO4,
TM9SF1, ADCY4, RIPK3, EAPP, BAZ1A, NFKBIA, SEC23A, C14orf104,
C14orf138, SOS2, NIN, PYGL, CNIH, DHRS7, WDR89, ACTN1, NUMB,
C14orf43, ABCD4, KIAA0317, NEK9, ANGE1, SPTLC2, SERPINA6, DICER1,
BCL11B, ANKRD9, PPP1R13B, AKT1, BRF1, TUBGCP5, SNRPN//SNURF//IP
W//SNORD116-16//SNORD116-18//SNORD116-21//SNORD116-22//SNORD116-17//SNORD-
116-19//PAR5//PAR-SN//SNORD116-2//SNORD116-25//SNORD116-26//SNORD107//SNOR-
D115-12//SNORD115-5//SNORD115-6//SNORD115-9//SNORD116-11//SNORD116-12//SNO-
RD116-13//SNORD116-28//SNORD116-4//SNORD64//PAR1//SNORD109A//SNORD109B//SN-
ORD116-6//SNORD116-3//SNORD116-9//SNORD115-13//SNORD115-1//SNORD115-14//SN-
ORD115-15//SNORD115-21//SNORD115-10//SNORD115-7//SNORD115-16//SNORD115-40/-
/SNORD115-42//SNORD115-11//SNORD115-29//SNORD115-34//SNORD115-36//SNORD115-
-4//SNORD115-43//HBII-52-24//SNORD116-5//SNORD116-7//SNORD115-26//SNORD115-
-30//SNORD116-15//SNORD116-8//SNORD115-2//SNORD115-39//SNORD116-14//SNORD1-
16-20//SNORD115-8//SNORD115-3//SNORD115-38//SNORD115-41//SNORD115-22//SNOR-
D115-44//SNORD116-1//SNORD115-17//SNORD115-18//SNORD115-19//SNORD115-20//S-
NORD116@, APBA2, MTMR15//MTMR10, RYR3, BAHD1, CHP,
JMJD7-PLA2G4B//JMJD7//PLA2G4B, HAUS2, C15orf63//SERF2, B2M, TRIM69,
PLDN, SQRDL, GALK2, USPS, GLDN, MAPK6, LACTB, RAB8B, APH1B,
USP3//LOC1001308 55, SNX1, LBXCORH/PIAS1//CALML4, NE01, MPI,
FBXO22//FBXO220S, RCN2, FAH, IL16, ABHD2, SLCO3A1, MCTP2,
MEF2A//LYSMD4, NIPA2//CYFIP1, HERC2//HERC2P2//HERC2P3//LOC440248,
MTMR10//MTMR15, C15orf24, SLC12A6, LPCAT4, INO80, OIP5, ZFP106,
CDAN1, SPG11//ISLR, SPPL2A, GNB5//LOC100129973, MYO5A, ARPP19,
RAB27A, CCPG1//PIGB//DYX1C1, BNIP2, CAl2, FAM96A,
KIAA0101//CSNK1G1, TLE3, PARP6, NPTN, MAN2C1, IMP3, MTHFS,
ST20//C15orf37, TMC3, AP3B2, C15orf40, WDR73, NTRK3, DET1, TM2D3,
WDR90, RHOT2//FBXL16, TMEM204, CRAMP1L//HN1L, MAPK8IP3, TBL3, TSC2,
KCTD5//PRO0461//PDPK1, CLUAP1, DNASE1, DNAJA3, CP110, C16orf62,
LYRM1, METTL9, EEF2K, POLR3E, PLK1, PRKCB, IL21R//LOC283888,
SULT1A2//SULT1A1, ATXN2L,
LAT//SPNS1//NPIPL2//LOC728741//LOC730153//NPIPL3//SPINH/LOC728888-
//LOC100289169//LOC728734//LOC729602//LOC100288442//LOC100288332,
KIF22, MAZ, CORO1A//LOC606724, ITGAL, SRCAP//SNORA30,
ZNF646//ZNF668, C16orf67, TMEM188, LPCAT2, CETP, CKLF, CMTM1//CKLF,
TMEM208, CTCF, THAP11, NUTF2, EDC4, SLC7A6//SLC7A60S, PRMT7, SNTB2,
VPS4A, DDX19B//DDX19A, CHST4, HP//HPR, PLCG2, KLHL36, KIAA0182,
BANP//RUNDC2C, TRAPPC2L, SPG7, CDK10, TCF25, AFG3L1, LUC7L, AXIN1,
JMJD8, LMF1, UNKL, UNKL, CLCN7, MRPS34, RNPS1, NLRC3,
TRAP1//DNASE1, ADCY9, CORO7, C16orf72,
RRN3//LOC653390//LOC730092//LOC100131998, XYLTH/LYRM2//ZC3H11A,
DCUN1D3//LYRM1, IGSF6//METTL9, CDR2//RRN3//LOC100131998//LOC653390,
COG7, GGA2, NSMCE1, GTF3C1, CCDC101//LOC388242, C16orf54, KCTD13,
SEPT1, ZNF764//ZNF747, C16orf58//LOC100128371, ITFG1,
ABCC11//LONP2, NUDT21, BBS2//OGFOD1, CSNK2A2, GOT2, FAM96B,
FHOD1//SLC9A5, ATP6VOD1//LOC100132855, GFOD2, SLC12A4, DPEP3,
DPEP2, CHTF8//HAS3, COG8//PDF, TERF2, AARS, ST3 GAL2, VA
C14//LOC100130894, AP1G1, WDR59, CTRB2//CTRB1, TAF1C//ADAD2,
FBXO31, ZCCHC14, FAM38A, CENPBD1, TIMM22, RPA1, DPH1//OVCA2, SGSM2,
ARRB2, LOC100130950, DNAH2, PIGL, TRPV2, MPRIP, DRG2,
ALKBH5//FLJ13773, SMCR7, WSB1, TAOK1, CPD, SUZ12P, RNF135, ZNF830,
TAF15, GGNBP2, LASP1, PSMD3, CDC6, NBR2, TMUB2, MGC57346//C17orf69,
NSF//LOC728806, GOSR2, NPEPPS//TBC1D3F//LOC440434, KPNB1, CDK5RAP3,
ATP5G1, UBE2Z, XYLT2//LOC100130580, NOG, DGKE, AKAP1,
TMEM49//CLTC//MIR21, CLTC, CA4, C17orf64, DCAF7, PITPNC1,
NOL11//SNORA38B, MAP2K6, COG1, CD300A, TMEM104, MRPS7, KIAA0195,
T5EN54, LLGL2, LOC100134934//CDK3, MFSD11, SEPT9, TNRC6C, TMC8,
ENGASE, RPTOR, GPS1, FN3KRP, TBCD, GEMIN4, GLOD4, SLC43A2, PRPF8,
SMG6//C17orf6, METT10D//LOC284009, SHPK, TAX1BP3, P2RX5,
MYBBP1A//SPNS2, PELP1, PFN1, ZNF232, DHX33, DERL2,
NLRP1//LOC728392, ASGR2, NEURL4//GPS2//D4S234E, ZBTB4, TP53, VAMP2,
PIK3R5, ELAC2, NCOR1//C20orf191//LOC100131704, ZNF287,
TOM1L2//LOC246315, GRAP//SNORD3B-1//SNORD3B-2//LOC400581, ALDOC,
SDF2, RAB34, PHF12, NUFIP2, OMG, EVI2B, C17orf66//RSL24D1,
SYNRG//LOC100131822, PLXDC1, CACNB1, PGAP3, MED24, NR1D1//THRA,
CCR7, STAT5B//STAT5A, FAM134C, VAT1, DUSP3, C17orf65//ASB16, UBTF,
GPATCH8, MAP3K14//LOC100133991, OSBPL7, SLC35B1, TOB1,
COX11//TOM1L1, VEZF1, SFRS1//FLJ44342, SEPT4, MED13//LOC100129112,
LIMD2//MAP3K3, STRADA, FTSJ3, CD79B, ICAM2, ERN1, TEX2,
LRRC37A3//LRRC37A2//LRRC37A//ARL17P1//LRRC37A4//LOC100294335//LOC644397,
GNA13, WIPI1//ARSG, FAM20A, NAT9, GGA3, H3F3B//H3F3C, EXOC7, SFRS2,
TMC6//LOC100131096, USP36, CD7, RAB31, VAPA, SEH1L, HQ0644/PRO0644,
RNMT, RNF138, GALNT1, ELP2, PIK3C3, SLC14A2, ME2,
SERPINB2//SERPINB10, ZNF407, ZNF236, NFATC1//LOC100127994,
ENOSF1//TYMS, MYOM1, AFG3L2, ABHD3, OSBPL1A, CDH2, DSC1, PSTPIP2,
C18orf32, MBD2//SNORA37, PIGN, TMX3, PQLC1, GZMM, ARID3A, CIRBP,
DAZAP1, SPPL2B, NFIC, VAV1, ARHGEF18//LOC100128573,
STXBP2//L00554363//LOC100131801, C19orf59, ZNF317, ILF3, SMARCA4,
PRKCSH, IER2, CCDC130, DCAF15, IL27RA, KLF2, SIN3B, DDA1, GTPBP3,
FAM129C, FCHO1, ARRDC2, IFI30, C19orf60, CRTC1//MAML2,
RFXANK//MEF2B//LOC729991, ZNF101, ZNF738,
ZNF257//ZNF492//ZNF99//ZNF98//LOC646864, C19orf2,
KIAA0355//FLJ21369, USF2, TMEM147, LIN37//PSENEN, C19orf55,
TBCB//POLR2I, ZNF382, ZNF568, ZNF420, ZNF383, CCDC97, ZNF574,
CD177, ZNF230//ZNF222, VASP, GRWD1, FLT3LG, ZNF175, NCRNA00085,
PPP2R1A, ZNF808//ZNF578//ZNF611, LENG8, FCAR, RPL28, U2AF2,
LOC100288114//MGC9913, ZFP28, ZNF460, ZNF549, ZNF211,
ZNF587//ZNF417, ZNF274, ZNF544, ZNF8, TRIM28, C19orf6, C19orf34,
GNG7, AES, EEF2//SNORD37, PLIN5ARG1, PLIN3, PTPRS, SAFB2//SAFB,
RANBP3, GTF2F1//LOC100130856, XAB2, ELAVL1, ADAMTS10, FBXL12,
DNMT1, TYK2, KEAP1, KRI1, TMEM205//hCG29977, ZNF563, MAN2B1//MORG1,
C19orf56, DHPS, TNPO2//SNORD41, LPHN1, NDUFB7, AKAP8, AKAP8L,
CHERP//C19orf44//CALR3, INSL3//JAK3, IL12RB1, UPK1A, TYROBP,
ZNF529, ZNF461, ZNF607, YIF1B, PRR13, CEACAM4, PLAUR, TRAPPC6A,
ERCC1//CD3EAP, RTN2, SYMPK, PGLYRP1, NOSIP, PNKP, NKG7, FPR1,
ZNF28, OSCAR, MBOAT7, LILRA5, LILRA4, ZNF550//ZNF549, ZNF416,
ZNF256, ZNF329, FAM110A, ITPA, CDC25B, CDS2, CRLS1, CSRP2BP,
SEC23B, SLC24A3, HCK, ASXL1, ACSS2, C20orf4, TGIF2, C20orf24//SLA2,
RPN2//EEF1A2, CTNNBL1, ACTR5, PPP1R16B, DHX35, PLCG1, MYBL2,
SYS1//SYS1-DBNDD2//DBNDD2, DNTTIP1, CTSA, MMP9//LOC100128028,
DDX27, SLC9A8, RNF114, PTPN1, TSHZ2, PFDN4, CSTF1, CASS4, GNAS,
C20orf177, CDH26, C20orf197, LOC284757, ARFGAP1, PRPF6, NSFL1C,
SIRPD, SIRPG//SIRPA, RNF24, RASSF2, TMX4, JAG1, C20orf74, C20orf3,
C20orf112, CDK5RAP1, AHCY, GGT7, EDEM2, RBM39//LOC643167, BLCAP,
SERINC3//TTPAL, ZNF335, ELMO2, B4GALT5, DPM1, ZFP64, ZNF217, CTSZ,
SYCP2, PSMA7, DID01, YTHDF1, CHODL, BACH1, C21orf41//BACH1, IL10RB,
IFNAR1, IFNGR2, SON, MORC3//DOPEY2, DYRK1A, KCNJ15, ETS2, RRP1B,
PFKL, TRPM2, ADARB1, SAMSN1//LOC388813, N6AMT1, SYNJ1, TMEM50B,
KCNE1, PRDM15, C2CD2, WDR4, U2AF1, CSTB, UBE2G2//SUMO3, PTTGlIP,
POFUT2, MCM3AP, IL17RA//CECR7, C22orf37, LZTR1, PPIL2//YPEL1,
CYTSA, SNRPD3//C22orf13, NF2, LIMK2, SLC5A1, MCM5, NCF4, GGA1,
SH3BP1//PDXP, POLR2F//LOC100131530, APOBEC3A//APOBEC3B, APOBEC3D,
ATF4, CACNA1I, ZC3H7B, CCDC134, TSPO, NUP50,
TBC1D22A//LOC100289878, RP3-402G11.5, SAPS2, NCAPH2, BID, SLC25A1,
KLHL22//KRT18, PI4KA//PI4KAP1//PI4KAP2//LOC100293141, MAPK1, ZNF70,
TPST2, SF3A1//CCDC157, PES1, PIK3IP1, PATZ1, C22orf30, IL2RB,
CSNK1E//LOC400927, UNC84B, CBX7//LOC100128400, RPS19BP1,
MKL1//KIAA1659, RANGAP1, TCF20, LDOC1L, UNQ6126, TUBGCP6,
SBF1//SBF1P1, MSL3, MOSPD2, BMX//HNRPDL, PDHA1, YY2, PDK3,
GK//GK3P//FTL//LOC652904, CXorf59, ATP6AP2, USP9X//USP9Y, RP2,
USP11, RBM3, FTSJ1, WAS, PLP2, TSPYL2//GPR173, MAGED2, UBQLN2,
NLGN3, ACRC, UPRT, CXorf26, ATP7A, DIAPH2, CSTF2//RAD21, ARMCX3,
ARMCX5, GPRASP1, TMEM31, TBC1D8B, MID2, DOCK11, LONRF3, UBE2A,
SH2D1A, OCRL, SLC25A14, HPRT1, CD40LG, AFF2, SSR4//IDH3G, FAM50A,
DKC1//SNORA36A//SNORA56, ARSD, KAL1, CTPS2, RPS6KA3, BCOR,
MAOB//NAT13, ZNF41, OTUD5, KCND1, ZMYM3, MAGT1, BRWD3, TRMT2B, GLA,
MORF4L2, PSMD10, ACSL4, LAMP2, CUL4B, ODZ1, ELF4, RAP2C,
FAM127B//FAM127C//FAM127A, TMEM185A, ARD1A, IRAK1, DNASE1L1//RPL10,
SH3KBP1, Mitochondrial, Mitochondrial, CCNL2, INPP5B, TLR5,
ADRB3//GOT1L1, NOC2L//SAMD11//LOC401010 and SHFM1 (hereafter
referred to interchangeably herein as "the full list of IRS immune
system biomarker genes" or "full list IRS biomarker genes").
[1002] The methods, compositions, apparatus and kits of the present
invention take advantage of the IRS biomarkers broadly described
above and elsewhere herein to provide an indicator for use in
diagnosing the presence, absence or degree of the at least one
condition selected from a healthy condition (e.g., a normal
condition or one in which inSIRS and inSIRS are absent), inSIRS,
ipSIRS or a stage of ipSIRS (e.g., a stage of ipSIRS with a
particular severity such as mild sepsis, severe sepsis and septic
shock), or in providing a prognosis of the at least one condition,
which may involve: (a) determining a plurality of IRS biomarker
values, each IRS biomarker value being indicative of a value
measured or derived for at least one (e.g., 1, 2, 3, 4, 5, 6, 7, 8,
9, 10, or more) IRS biomarker of a biological subject; (b)
determining the indicator using a combination of the plurality of
IRS biomarker values (also referred to herein as a "biomarker
signature"), the indicator being at least partially indicative of
the presence, absence, degree or prognosis of the at least one
condition, wherein: (i) at least two (e.g., 2, 3, 4, 5, 6, 7, 8, 9,
10, or more) IRS biomarkers have a mutual correlation in respect of
the at least one condition that lies within a mutual correlation
range, the mutual correlation range being between .+-.0.9; and (ii)
the indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3.
[1003] In advantageous embodiments, the diagnostic or prognostic
methods, compositions, apparatus and kits of the present invention
involve: (1) determining a plurality of measured IRS biomarker
values, each measured IRS biomarker value being a measured value of
an IRS biomarker of the biological subject; and (2) applying a
function to at least one of the measured IRS biomarker values to
determine at least one derived IRS biomarker value, the at least
one derived IRS biomarker value being indicative of a value of a
corresponding derived IRS biomarker. The function suitably includes
at least one of: (a) multiplying two IRS biomarker values; (b)
dividing two IRS biomarker values; (c) adding two IRS biomarker
values; (d) subtracting two IRS biomarker values; (e) a weighted
sum of at least two IRS biomarker values; (f) a log sum of at least
two IRS biomarker values; and (g) a sigmoidal function of at least
two IRS biomarker values.
[1004] In some embodiments, the diagnostic or prognostic methods,
compositions, apparatus and kits involve: determining at least one
derived IRS biomarker value corresponding to a ratio of two
measured IRS biomarker values. In these examples, the diagnostic or
prognostic methods, apparatus and kits suitably include combining
at least two IRS biomarker values to determine an indicator value
representing the indicator and in illustrative examples of this
type, the at least two IRS biomarker values are combined using a
combining function (e.g., any one or more of: an additive model; a
linear model; a support vector machine; a neural network model; a
random forest model; a regression model; a genetic algorithm; an
annealing algorithm; weighted sum; a nearest neighbor model; and a
probabilistic model). Suitably, the diagnostic or prognostic
methods, apparatus and kits include: (a) determining a first
derived IRS biomarker value, the first derived IRS biomarker value
being a ratio of first and second measured IRS biomarker values;
(b) determining a second derived IRS biomarker value, the second
derived IRS biomarker value being a ratio of third and fourth
measured IRS biomarker values; and (c) adding the first and second
derived IRS biomarker values to generate an indicator value.
[1005] In some embodiments, the methods, compositions, kits and
apparatus of the present invention are useful for diagnosing that
inSIRS or a healthy condition is present or absent in the
biological subject, which suitably involve: (a) determining a
plurality of IRS biomarker values, each IRS biomarker value being
indicative of a value measured or derived for at least one IRS
biomarker of a biological subject; (b) determining the indicator
using a combination of the plurality of IRS biomarker values, the
at least one indicator being at least partially indicative of the
presence, absence, degree or prognosis of the at least one
condition selected from inSIRS and a healthy condition, wherein:
(i) at least two IRS biomarkers have a mutual correlation in
respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group A IRS biomarker genes as
defined herein, and wherein the second IRS biomarker group consists
of polynucleotide and/or polypeptide expression products from group
B IRS biomarker genes as defined herein.
[1006] In other embodiments, the methods, apparatus and kits are
useful for diagnosing that ipSIRS or a healthy condition is present
or absent in the biological subject, which suitably involve: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one IRS biomarker of a biological subject; (b) determining the
indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from ipSIRS and a healthy condition,
wherein: (i) at least two IRS biomarkers have a mutual correlation
in respect of the at least one condition that lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the indicator has a performance value greater
than or equal to a performance threshold representing the ability
of the indicator to diagnose the presence, absence or degree of the
at least one condition, or to provide a prognosis for the at least
one condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group C IRS biomarker genes,
as defined herein, and wherein the second IRS biomarker group
consists of polynucleotide and/or polypeptide expression products
from group D IRS biomarker genes as defined herein.
[1007] In still other embodiments, the methods, apparatus and kits
are useful for diagnosing that inSIRS or ipSIRS is present or
absent in the biological subject, which suitably involve: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one IRS biomarker of a biological subject; (b) determining the
indicator using a combination of the plurality of IRS biomarker
values, the at least one indicator being at least partially
indicative of the presence, absence, degree or prognosis of the at
least one condition selected from inSIRS and ipSIRS, wherein: (i)
at least two IRS biomarkers have a mutual correlation in respect of
the at least one condition that lies within a mutual correlation
range, the mutual correlation range being between .+-.0.9; and (ii)
the indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least two IRS biomarkers is selected from a first IRS biomarker
group and wherein at least one other of the at least two IRS
biomarkers is selected from a second IRS biomarker group, wherein
the first IRS biomarker group consists of polynucleotide and/or
polypeptide expression products from group E IRS biomarker genes as
defined herein, and wherein the second IRS biomarker group consists
of polynucleotide and/or polypeptide expression products from group
F IRS biomarker genes as defined herein.
[1008] In other embodiments, the methods, apparatus and kits are
useful for diagnosing that inSIRS or ipSIRS is present or absent in
the biological subject, which suitably involve: (a) determining a
plurality of IRS biomarker values, each IRS biomarker value being
indicative of a value measured or derived for at least one IRS
biomarker of a biological subject; (b) determining the indicator
using a combination of the plurality of IRS biomarker values, the
at least one indicator being at least partially indicative of the
presence, absence, degree or prognosis of the at least one
condition selected from inSIRS and ipSIRS, wherein: (i) at least
four IRS biomarkers have a mutual correlation in respect of the at
least one condition that lies within a mutual correlation range,
the mutual correlation range being between .+-.0.9; and (ii) the
indicator has a performance value greater than or equal to a
performance threshold representing the ability of the indicator to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein at least one of the at
least four IRS biomarkers is selected from a first IRS biomarker
group, wherein at least one other of the at least four IRS
biomarkers is selected from a second IRS biomarker group, wherein
at least one other of the at least four IRS biomarkers is selected
from a third IRS biomarker group, and wherein at least one other of
the at least four IRS biomarkers is selected from a fourth IRS
biomarker group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group G
IRS biomarker genes as defined herein, wherein the second IRS
biomarker group consists of polynucleotide and/or polypeptide
expression products from group H IRS biomarker genes as defined
herein, wherein the third IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group I
IRS biomarker genes as defined herein, and wherein the fourth IRS
biomarker group consists of polynucleotide and/or polypeptide
expression products from group J IRS biomarker genes as defined
herein.
[1009] In still other embodiments, the methods, apparatus and kits
are useful for diagnosing that mild sepsis or severe sepsis is
present or absent in the biological subject, which suitably
involve: (a) determining a plurality of IRS biomarker values, each
IRS biomarker value being indicative of a value measured or derived
for at least one IRS biomarker of a biological subject; (b)
determining the indicator using a combination of the plurality of
IRS biomarker values, the at least one indicator being at least
partially indicative of the presence, absence, degree or prognosis
of the at least one condition selected from mild sepsis and severe
sepsis, wherein: (i) at least two IRS biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the indicator has a performance
value greater than or equal to a performance threshold representing
the ability of the indicator to diagnose the presence, absence or
degree of the at least one condition, or to provide a prognosis for
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3, wherein at
least one of the at least two IRS biomarkers is selected from a
first IRS biomarker group and wherein at least one other of the at
least two IRS biomarkers is selected from a second IRS biomarker
group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group K
IRS biomarker genes as defined herein, and wherein the second IRS
biomarker group consists of polynucleotide and/or polypeptide
expression products from group L IRS biomarker genes as defined
herein.
[1010] In still other embodiments, the methods, apparatus and kits
are useful for diagnosing that mild sepsis or septic shock is
present or absent in the biological subject, which suitably
involve: (a) determining a plurality of IRS biomarker values, each
IRS biomarker value being indicative of a value measured or derived
for at least one IRS biomarker of a biological subject; (b)
determining the indicator using a combination of the plurality of
IRS biomarker values, the at least one indicator being at least
partially indicative of the presence, absence, degree or prognosis
of the at least one condition selected from mild sepsis and septic
shock, wherein: (i) at least two IRS biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the indicator has a performance
value greater than or equal to a performance threshold representing
the ability of the indicator to diagnose the presence, absence or
degree of the at least one condition, or to provide a prognosis for
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3, wherein at
least one of the at least two IRS biomarkers is selected from a
first IRS biomarker group and wherein at least one other of the at
least two IRS biomarkers is selected from a second IRS biomarker
group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group M
IRS biomarker genes as defined herein, and wherein the second IRS
biomarker group consists of polynucleotide and/or polypeptide
expression products from group N IRS biomarker genes as defined
herein.
[1011] In still other embodiments, the methods, apparatus and kits
are useful for diagnosing that severe sepsis or septic shock is
present or absent in the biological subject, which suitably
involve: (a) determining a plurality of IRS biomarker values, each
IRS biomarker value being indicative of a value measured or derived
for at least one IRS biomarker of a biological subject; (b)
determining the indicator using a combination of the plurality of
IRS biomarker values, the at least one indicator being at least
partially indicative of the presence, absence, degree or prognosis
of the at least one condition selected from severe sepsis and
septic shock, wherein: (i) at least two IRS biomarkers have a
mutual correlation in respect of the at least one condition that
lies within a mutual correlation range, the mutual correlation
range being between .+-.0.9; and (ii) the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence or degree of the at least one condition, or to provide a
prognosis for the at least one condition, the performance threshold
being indicative of an explained variance of at least 0.3, wherein
at least one of the at least two IRS biomarkers is selected from a
first IRS biomarker group and wherein at least one other of the at
least two IRS biomarkers is selected from a second IRS biomarker
group, wherein the first IRS biomarker group consists of
polynucleotide and/or polypeptide expression products from group O
IRS biomarker genes as defined herein, and wherein the second IRS
biomarker group consists of polynucleotide and/or polypeptide
expression products from group P IRS biomarker genes as defined
herein.
[1012] As used herein, the terms "diagnosis", "diagnosing" and the
like are used interchangeable herein to encompass determining the
likelihood that a subject will develop a condition, or the
existence or nature of a condition in a subject. These terms also
encompass determining the severity of disease or episode of
disease, as well as in the context of rational therapy, in which
the diagnosis guides therapy, including initial selection of
therapy, modification of therapy (e.g., adjustment of dose or
dosage regimen), and the like. By "likelihood" is meant a measure
of whether a biological subject with particular measured or derived
biomarker values actually has a condition (or not) based on a given
mathematical model. An increased likelihood for example may be
relative or absolute and may be expressed qualitatively or
quantitatively. For instance, an increased likelihood may be
determined simply by determining the subject's measured or derived
biomarker values for at least two IRS biomarkers and placing the
subject in an "increased likelihood" category, based upon previous
population studies. The term "likelihood" is also used
interchangeably herein with the term "probability".
[1013] In some embodiments, the biomarkers, including IRS
biomarkers, are obtained from a biological sample. The term
"biological sample" as used herein refers to a sample that may be
extracted, untreated, treated, diluted or concentrated from an
animal. The biological sample is suitably a biological fluid such
as whole blood, serum, plasma, saliva, urine, sweat, ascitic fluid,
peritoneal fluid, synovial fluid, amniotic fluid, cerebrospinal
fluid, tissue biopsy, and the like. In certain embodiments, the
biological sample contains blood, especially peripheral blood, or a
fraction or extract thereof. Typically, the biological sample
comprises blood cells such as mature, immature or developing
leukocytes, including lymphocytes, polymorphonuclear leukocytes,
neutrophils, monocytes, reticulocytes, basophils, coelomocytes,
hemocytes, eosinophils, megakaryocytes, macrophages, dendritic
cells natural killer cells, or fraction of such cells (e.g., a
nucleic acid or protein fraction). In specific embodiments, the
biological sample comprises leukocytes including peripheral blood
mononuclear cells (PBMC). By "obtained from" is meant to come into
possession. Biological or reference samples so obtained include,
for example, nucleic acid extracts or polypeptide extracts isolated
or derived from a particular source. For instance, the extract may
be isolated directly from a biological fluid or tissue of a
subject.
[1014] The term "nucleic acid" or "polynucleotide" as used herein
includes RNA, mRNA, miRNA, cRNA, cDNA mtDNA, or DNA. The term
typically refers to a polymeric form of nucleotides of at least 10
bases in length, either ribonucleotides or deoxynucleotides or a
modified form of either type of nucleotide. The term includes
single and double stranded forms of DNA or RNA.
[1015] "Protein", "polypeptide" and "peptide" are used
interchangeably herein to refer to a polymer of amino acid residues
and to variants and synthetic analogues of the same.
[1016] In some embodiments, biomarker signatures are determined
through analysis of measured or derived IRS biomarker values for
IRS biomarkers of one or more control subjects that have or do not
have a condition. These biomarkers are referred to herein as
"reference IRS biomarkers". In specific examples, individual
control subjects are selected from "healthy control subjects",
"non-healthy control subjects", "SIRS control subjects", "inSIRS
control subjects", "ipSIRS control subjects", "control subjects
with a particular stage of ipSIRS", illustrative examples of which
include "mild sepsis control subjects", "severe sepsis control
subjects" and "septic shock control subjects", etc.), which are
also referred to herein as control groups (e.g., "healthy control
group", "non-healthy control group", "SIRS control group", "inSIRS
control group", "ipSIRS control group", "ipSIRS stage group",
illustrative examples of which include "mild sepsis control group",
"severe sepsis control group", and "septic shock control group",
etc.).
[1017] Suitably, an individual measured or derived IRS biomarker
value corresponds to the level or amount of a respective IRS
biomarker or to a function that is applied to that level or amount.
As used herein the terms "level" and "amount" are used
interchangeably herein to refer to a quantitative amount (e.g.,
weight or moles), a semi-quantitative amount, a relative amount
(e.g., weight % or mole % within class), a concentration, and the
like. Thus, these terms encompass absolute or relative amounts or
concentrations of IRS biomarkers in a sample.
[1018] In some embodiments, the presence, absence, degree or
prognosis of at least one condition in a biological subject is
established by determining a plurality of IRS biomarker values,
wherein each IRS biomarker value is indicative of a value measured
or derived for at least one IRS biomarker in a biological sample
obtained from the biological subject. These biomarkers are referred
to herein as "sample IRS biomarkers". In accordance with the
present invention, a sample IRS biomarker corresponds to a
reference IRS biomarker (also referred to herein as a
"corresponding IRS biomarker"). By "corresponding IRS biomarker" is
meant an IRS biomarker that is structurally and/or functionally
similar to a reference IRS biomarker. Representative corresponding
IRS biomarkers include expression products of allelic variants
(same locus), homologues (different locus), and orthologues
(different organism) of reference IRS biomarker genes. Nucleic acid
variants of reference IRS biomarker genes and encoded IRS biomarker
polynucleotide expression products can contain nucleotide
substitutions, deletions, inversions and/or insertions. Variation
can occur in either or both the coding and non-coding regions. The
variations can produce both conservative and non-conservative amino
acid substitutions (as compared in the encoded product). For
nucleotide sequences, conservative variants include those sequences
that, because of the degeneracy of the genetic code, encode the
amino acid sequence of a reference IRS polypeptide.
[1019] Generally, variants of a particular IRS biomarker gene or
polynucleotide will have at least about 40%, 45%, 50%, 51%, 52%,
53%, 54%, 55%, 56%, 57%, 58%, 59% 60%, 61%, 62%, 63%, 64%, 65%,
66%, 67%, 68%, 69% 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%,
79%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%,
92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more sequence identity to
that particular nucleotide sequence as determined by sequence
alignment programs known in the art using default parameters. In
some embodiments, the IRS biomarker gene or polynucleotide displays
at least about 40%, 45%, 50%, 51%, 52%, 53%, 54%, 55%, 56%, 57%,
58%, 59% 60%, 61%, 62%, 63%, 64%, 65%, 66%, 67%, 68%, 69% 70%, 71%,
72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%, 81%, 82%, 83%, 84%,
85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%,
98%, 99% or more sequence identity to a nucleotide sequence
selected from any one of SEQ ID NO: 1-1650, as summarized in Table
1.
[1020] Corresponding IRS biomarkers also include amino acid
sequences that display substantial sequence similarity or identity
to the amino acid sequence of a reference IRS biomarker
polypeptide. In general, an amino acid sequence that corresponds to
a reference amino acid sequence will display at least about 50, 51,
52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68,
69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85,
86, 97, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% or even up
to 100% sequence similarity or identity to a reference amino acid
sequence selected from any one of SEQ ID NO: 1651-3284, as
summarized in Table 2.
[1021] In some embodiments, calculations of sequence similarity or
sequence identity between sequences are performed as follows:
[1022] To determine the percentage identity of two amino acid
sequences, or of two nucleic acid sequences, the sequences are
aligned for optimal comparison purposes (e.g., gaps can be
introduced in one or both of a first and a second amino acid or
nucleic acid sequence for optimal alignment and non-homologous
sequences can be disregarded for comparison purposes). In some
embodiments, the length of a reference sequence aligned for
comparison purposes is at least 30%, usually at least 40%, more
usually at least 50%, 60%, and even more usually at least 70%, 80%,
90%, 100% of the length of the reference sequence. The amino acid
residues or nucleotides at corresponding amino acid positions or
nucleotide positions are then compared. When a position in the
first sequence is occupied by the same amino acid residue or
nucleotide at the corresponding position in the second sequence,
then the molecules are identical at that position. For amino acid
sequence comparison, when a position in the first sequence is
occupied by the same or similar amino acid residue (i.e.,
conservative substitution) at the corresponding position in the
second sequence, then the molecules are similar at that
position.
[1023] The percentage identity between the two sequences is a
function of the number of identical amino acid residues shared by
the sequences at individual positions, taking into account the
number of gaps, and the length of each gap, which need to be
introduced for optimal alignment of the two sequences. By contrast,
the percentage similarity between the two sequences is a function
of the number of identical and similar amino acid residues shared
by the sequences at individual positions, taking into account the
number of gaps, and the length of each gap, which need to be
introduced for optimal alignment of the two sequences.
[1024] The comparison of sequences and determination of percentage
identity or percentage similarity between sequences can be
accomplished using a mathematical algorithm. In certain
embodiments, the percentage identity or similarity between amino
acid sequences is determined using the Needleman and Wunsch, (1970,
J. Mol. Biol. 48: 444-453) algorithm which has been incorporated
into the GAP program in the GCG software package (available at
http://www.gcg.com), using either a Blossum 62 matrix or a PAM250
matrix, and a gap weight of 16, 14, 12, 10, 8, 6, or 4 and a length
weight of 1, 2, 3, 4, 5, or 6. In specific embodiments, the percent
identity between nucleotide sequences is determined using the GAP
program in the GCG software package (available at
http://www.gcg.com), using a NWSgapdna.CMP matrix and a gap weight
of 40, 50, 60, 70, or 80 and a length weight of 1, 2, 3, 4, 5, or
6. An non-limiting set of parameters (and the one that should be
used unless otherwise specified) includes a Blossum 62 scoring
matrix with a gap penalty of 12, a gap extend penalty of 4, and a
frameshift gap penalty of 5.
[1025] In some embodiments, the percentage identity or similarity
between amino acid or nucleotide sequences can be determined using
the algorithm of E. Meyers and W. Miller (1989, Cabios, 4: 11-17)
which has been incorporated into the ALIGN program (version 2.0),
using a PAM120 weight residue table, a gap length penalty of 12 and
a gap penalty of 4.
[1026] The nucleic acid and protein sequences described herein can
be used as a "query sequence" to perform a search against public
databases to, for example, identify other family members or related
sequences. Such searches can be performed using the NBLAST and
XBLAST programs (version 2.0) of Altschul, et al., (1990, J Mol
Biol., 215: 403-10). BLAST nucleotide searches can be performed
with the NBLAST program, score=100, wordlength=12 to obtain
nucleotide sequences homologous to 53010 nucleic acid molecules of
the invention. BLAST protein searches can be performed with the
XBLAST program, score=50, wordlength=3 to obtain amino acid
sequences homologous to YYYYY protein molecules of the invention.
To obtain gapped alignments for comparison purposes, Gapped BLAST
can be utilized as described in Altschul et al., (1997, Nucleic
Acids Res, 25: 3389-3402). When utilizing BLAST and Gapped BLAST
programs, the default parameters of the respective programs (e.g.,
XBLAST and NBLAST) can be used.
[1027] Corresponding IRS biomarker polynucleotides also include
nucleic acid sequences that hybridize to reference IRS biomarker
polynucleotides, or to their complements, under stringency
conditions described below. As used herein, the term "hybridizes
under low stringency, medium stringency, high stringency, or very
high stringency conditions" describes conditions for hybridization
and washing. "Hybridization" is used herein to denote the pairing
of complementary nucleotide sequences to produce a DNA-DNA hybrid
or a DNA-RNA hybrid. Complementary base sequences are those
sequences that are related by the base-pairing rules. In DNA, A
pairs with T and C pairs with G. In RNA, U pairs with A and C pairs
with G. In this regard, the terms "match" and "mismatch" as used
herein refer to the hybridization potential of paired nucleotides
in complementary nucleic acid strands. Matched nucleotides
hybridize efficiently, such as the classical A-T and G-C base pair
mentioned above. Mismatches are other combinations of nucleotides
that do not hybridize efficiently.
[1028] Guidance for performing hybridization reactions can be found
in Ausubel et al., (1998, supra), Sections 6.3.1-6.3.6. Aqueous and
non-aqueous methods are described in that reference and either can
be used. Reference herein to low stringency conditions include and
encompass from at least about 1% v/v to at least about 15% v/v
formamide and from at least about 1 M to at least about 2 M salt
for hybridization at 42.degree. C., and at least about 1 M to at
least about 2 M salt for washing at 42.degree. C. Low stringency
conditions also may include 1% Bovine Serum Albumin (BSA), 1 mM
EDTA, 0.5 M NaHPO.sub.4 (pH 7.2), 7% SDS for hybridization at
65.degree. C., and (i) 2.times.SSC, 0.1% SDS; or (ii) 0.5% BSA, 1
mM EDTA, 40 mM NaHPO.sub.4 (pH 7.2), 5% SDS for washing at room
temperature. One embodiment of low stringency conditions includes
hybridization in 6.times. sodium chloride/sodium citrate (SSC) at
about 45.degree. C., followed by two washes in 0.2.times.SSC, 0.1%
SDS at least at 50.degree. C. (the temperature of the washes can be
increased to 55.degree. C. for low stringency conditions). Medium
stringency conditions include and encompass from at least about 16%
v/v to at least about 30% v/v formamide and from at least about 0.5
M to at least about 0.9 M salt for hybridization at 42.degree. C.,
and at least about 0.1 M to at least about 0.2 M salt for washing
at 55.degree. C. Medium stringency conditions also may include 1%
Bovine Serum Albumin (BSA), 1 mM EDTA, 0.5 M NaHPO.sub.4 (pH 7.2),
7% SDS for hybridization at 65.degree. C., and (i) 2.times.SSC,
0.1% SDS; or (ii) 0.5% BSA, 1 mM EDTA, 40 mM NaHPO.sub.4 (pH 7.2),
5% SDS for washing at 60-65.degree. C. One embodiment of medium
stringency conditions includes hybridizing in 6.times.SSC at about
45.degree. C., followed by one or more washes in 0.2.times.SSC,
0.1% SDS at 60.degree. C. High stringency conditions include and
encompass from at least about 31% v/v to at least about 50% v/v
formamide and from about 0.01 M to about 0.15 M salt for
hybridization at 42.degree. C., and about 0.01 M to about 0.02 M
salt for washing at 55.degree. C. High stringency conditions also
may include 1% BSA, 1 mM EDTA, 0.5 M NaHPO.sub.4 (pH 7.2), 7% SDS
for hybridization at 65.degree. C., and (i) 0.2.times.SSC, 0.1%
SDS; or (ii) 0.5% BSA, 1 mM EDTA, 40 mM NaHPO.sub.4 (pH 7.2), 1%
SDS for washing at a temperature in excess of 65.degree. C. One
embodiment of high stringency conditions includes hybridizing in
6.times.SSC at about 45.degree. C., followed by one or more washes
in 0.2.times.SSC, 0.1% SDS at 65.degree. C.
[1029] In certain embodiments, a corresponding IRS biomarker
polynucleotide is one that hybridizes to a disclosed nucleotide
sequence under very high stringency conditions. One embodiment of
very high stringency conditions includes hybridizing 0.5 M sodium
phosphate, 7% SDS at 65.degree. C., followed by one or more washes
at 0.2.times.SSC, 1% SDS at 65.degree. C.
[1030] Other stringency conditions are well known in the art and a
skilled addressee will recognize that various factors can be
manipulated to optimize the specificity of the hybridization.
Optimization of the stringency of the final washes can serve to
ensure a high degree of hybridization. For detailed examples, see
Ausubel et al., supra at pages 2.10.1 to 2.10.16 and Sambrook et
al. (1989, supra) at sections 1.101 to 1.104.
[1031] The IRS biomarkers disclosed herein each have significant
sensitivity and specificity for diagnosing the presence, absence or
degree of at least condition selected from a healthy condition
(e.g., a normal condition or one in which inSIRS and inSIRS are
absent), inSIRS, ipSIRS or a stage of ipSIRS (e.g., a stage of
ipSIRS with a particular severity such as mild sepsis, severe
sepsis and septic shock). Accordingly, it is feasible to use
individual IRS biomarkers in methods, apparatus and kits that do
not rely on the use of low mutual correlation between biomarkers to
diagnose the presence, absence or degree of the at least condition.
In illustrative examples of this type, the invention contemplates
methods, kits and apparatus that are useful for diagnosing that
inSIRS or a healthy condition is present or absent in a biological
subject, which suitably involve: (1) correlating a reference
biomarker signature with the presence or absence of a condition
selected from inSIRS and a healthy condition, wherein the reference
biomarker signature evaluates at least one IRS biomarker; (2)
obtaining a biomarker signature of a sample from a subject, wherein
the sample biomarker signature evaluates for an individual IRS
biomarker in the reference biomarker signature a corresponding IRS
biomarker; and (3) diagnosing the presence or absence of the
condition in the subject based on the sample biomarker signature
and the reference biomarker signature, wherein an individual IRS
biomarker is an expression product of an IRS biomarker gene
selected from the group A and group B IRS biomarker genes as
defined herein.
[1032] In other non-limiting examples, the methods, apparatus and
kits are useful for diagnosing that ipSIRS or a healthy condition
is present or absent in the biological subject, which suitably
involve: (1) correlating a reference biomarker signature with the
presence or absence of a condition selected from ipSIRS and a
healthy condition, wherein the reference biomarker signature
evaluates at least one IRS biomarker; (2) obtaining a biomarker
signature of a sample from a subject, wherein the sample biomarker
signature evaluates for an individual IRS biomarker in the
reference biomarker signature a corresponding IRS biomarker; and
(3) diagnosing the presence or absence of the condition in the
subject based on the sample biomarker signature and the reference
biomarker signature, wherein an individual IRS biomarker is an
expression product of an IRS biomarker gene selected from the group
C and group D IRS biomarker genes as defined herein.
[1033] In still other non-limiting examples, the methods, apparatus
and kits are useful for diagnosing that inSIRS or ipSIRS is present
or absent in the biological subject, which suitably involve: (1)
correlating a reference biomarker signature with the presence or
absence of a condition selected from inSIRS and ipSIRS, wherein the
reference biomarker signature evaluates at least one IRS biomarker;
(2) obtaining a biomarker signature of a sample from a subject,
wherein the sample biomarker signature evaluates for an individual
IRS biomarker in the reference biomarker signature a corresponding
IRS biomarker; and (3) diagnosing the presence or absence of the
condition in the subject based on the sample biomarker signature
and the reference biomarker signature, wherein an individual IRS
biomarker is an expression product of an IRS biomarker gene
selected from the group E and group F IRS biomarker genes as
defined herein.
[1034] In still other illustrative examples, the methods, apparatus
and kits are useful for diagnosing that mild sepsis or severe
sepsis is present or absent in the biological subject, which
suitably involve: (1) correlating a reference biomarker signature
with the presence or absence of a condition selected from mild
sepsis and severe sepsis, wherein the reference biomarker signature
evaluates at least one IRS biomarker; (2) obtaining a biomarker
signature of a sample from a subject, wherein the sample biomarker
signature evaluates for an individual IRS biomarker in the
reference biomarker signature a corresponding IRS biomarker; and
(3) diagnosing the presence or absence of the condition in the
subject based on the sample biomarker signature and the reference
biomarker signature, wherein an individual IRS biomarker is an
expression product of an IRS biomarker gene selected from the group
K and group L IRS biomarker genes as defined herein.
[1035] In still other illustrative examples, the methods, apparatus
and kits are useful for diagnosing that mild sepsis or septic shock
is present or absent in the biological subject, which suitably
involve: (1) correlating a reference biomarker signature with the
presence or absence of a condition selected from mild sepsis and
septic shock, wherein the reference biomarker signature evaluates
at least one IRS biomarker; (2) obtaining a biomarker signature of
a sample from a subject, wherein the sample biomarker signature
evaluates for an individual IRS biomarker in the reference
biomarker signature a corresponding IRS biomarker; and (3)
diagnosing the presence or absence of the condition in the subject
based on the sample biomarker signature and the reference biomarker
signature, wherein an individual IRS biomarker is an expression
product of an IRS biomarker gene selected from the group M and
group N IRS biomarker genes as defined herein.
[1036] In other non-limiting examples, the methods, apparatus and
kits are useful for diagnosing that severe sepsis or septic shock
is present or absent in the biological subject, which suitably
involve: (1) correlating a reference biomarker signature with the
presence or absence of a condition selected from severe sepsis and
septic shock, wherein the reference biomarker signature evaluates
at least one IRS biomarker; (2) obtaining a biomarker signature of
a sample from a subject, wherein the sample biomarker signature
evaluates for an individual IRS biomarker in the reference
biomarker signature a corresponding IRS biomarker; and (3)
diagnosing the presence or absence of the condition in the subject
based on the sample biomarker signature and the reference biomarker
signature, wherein an individual IRS biomarker is an expression
product of an IRS biomarker gene selected from the group O and
group P IRS biomarker genes as defined herein.
[1037] The biomarkers may be quantified or detected using any
suitable technique. In specific embodiments, the biomarkers,
including the IRS biomarkers, are quantified using reagents that
determine the level or abundance of individual biomarkers.
Non-limiting reagents of this type include reagents for use in
nucleic acid- and protein-based assays.
[1038] In illustrative nucleic acid-based assays, nucleic acid is
isolated from cells contained in the biological sample according to
standard methodologies (Sambrook, et al., 1989, supra; and Ausubel
et al., 1994, supra). The nucleic acid is typically fractionated
(e.g., poly A.sup.+ RNA) or whole cell RNA. Where RNA is used as
the subject of detection, it may be desired to convert the RNA to a
complementary DNA. In some embodiments, the nucleic acid is
amplified by a template-dependent nucleic acid amplification
technique. A number of template dependent processes are available
to amplify the IRS biomarker sequences present in a given template
sample. An exemplary nucleic acid amplification technique is the
polymerase chain reaction (referred to as PCR), which is described
in detail in U.S. Pat. Nos. 4,683,195, 4,683,202 and 4,800,159,
Ausubel et al. (supra), and in Innis et al., ("PCR Protocols",
Academic Press, Inc., San Diego Calif., 1990). Briefly, in PCR, two
primer sequences are prepared that are complementary to regions on
opposite complementary strands of the biomarker sequence. An excess
of deoxynucleotide triphosphates are added to a reaction mixture
along with a DNA polymerase, e.g., Taq polymerase. If a cognate IRS
biomarker sequence is present in a sample, the primers will bind to
the biomarker and the polymerase will cause the primers to be
extended along the biomarker sequence by adding on nucleotides. By
raising and lowering the temperature of the reaction mixture, the
extended primers will dissociate from the biomarker to form
reaction products, excess primers will bind to the biomarker and to
the reaction products and the process is repeated. A reverse
transcriptase PCR amplification procedure may be performed in order
to quantify the amount of mRNA amplified. Methods of reverse
transcribing RNA into cDNA are well known and described in Sambrook
et al., 1989, supra. Alternative methods for reverse transcription
utilize thermostable, RNA-dependent DNA polymerases. These methods
are described in WO 90/07641. Polymerase chain reaction
methodologies are well known in the art.
[1039] In certain advantageous embodiments, the template-dependent
amplification involves quantification of transcripts in real-time.
For example, RNA or DNA may be quantified using the Real-Time PCR
technique (Higuchi, 1992, et al., Biotechnology 10: 413-417). By
determining the concentration of the amplified products of the
target DNA in PCR reactions that have completed the same number of
cycles and are in their linear ranges, it is possible to determine
the relative concentrations of the specific target sequence in the
original DNA mixture. If the DNA mixtures are cDNAs synthesized
from RNAs isolated from different tissues or cells, the relative
abundance of the specific mRNA from which the target sequence was
derived can be determined for the respective tissues or cells. This
direct proportionality between the concentration of the PCR
products and the relative mRNA abundance is only true in the linear
range of the PCR reaction. The final concentration of the target
DNA in the plateau portion of the curve is determined by the
availability of reagents in the reaction mix and is independent of
the original concentration of target DNA. In specific embodiments,
multiplexed, tandem PCR (MT-PCR) is employed, which uses a two-step
process for gene expression profiling from small quantities of RNA
or DNA, as described for example in US Pat. Appl. Pub. No.
20070190540. In the first step, RNA is converted into cDNA and
amplified using multiplexed gene specific primers. In the second
step each individual gene is quantitated by real time PCR.
[1040] In certain embodiments, target nucleic acids are quantified
using blotting techniques, which are well known to those of skill
in the art. Southern blotting involves the use of DNA as a target,
whereas Northern blotting involves the use of RNA as a target. Each
provides different types of information, although cDNA blotting is
analogous, in many aspects, to blotting or RNA species. Briefly, a
probe is used to target a DNA or RNA species that has been
immobilized on a suitable matrix, often a filter of nitrocellulose.
The different species should be spatially separated to facilitate
analysis. This often is accomplished by gel electrophoresis of
nucleic acid species followed by "blotting" on to the filter.
Subsequently, the blotted target is incubated with a probe (usually
labeled) under conditions that promote denaturation and
rehybridization. Because the probe is designed to base pair with
the target, the probe will bind a portion of the target sequence
under renaturing conditions. Unbound probe is then removed, and
detection is accomplished as described above. Following
detection/quantification, one may compare the results seen in a
given subject with a control reaction or a statistically
significant reference group or population of control subjects as
defined herein. In this way, it is possible to correlate the amount
of an IRS biomarker nucleic acid detected with the progression or
severity of the disease. As used herein, the term "probe" refers to
a molecule that binds to a specific sequence or sub-sequence or
other moiety of another molecule. Unless otherwise indicated, the
term "probe" typically refers to a nucleic acid probe that binds to
another nucleic acid, also referred to herein as a "target
polynucleotide", through complementary base pairing. Probes can
bind target polynucleotides lacking complete sequence
complementarity with the probe, depending on the stringency of the
hybridization conditions. Probes can be labeled directly or
indirectly and include primers within their scope. By "primer" is
meant an oligonucleotide which, when paired with a strand of DNA,
is capable of initiating the synthesis of a primer extension
product in the presence of a suitable polymerizing agent. The
primer is preferably single-stranded for maximum efficiency in
amplification but can alternatively be double-stranded. A primer
must be sufficiently long to prime the synthesis of extension
products in the presence of the polymerization agent. The length of
the primer depends on many factors, including application,
temperature to be employed, template reaction conditions, other
reagents, and source of primers. For example, depending on the
complexity of the target sequence, the primer may be at least about
5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,
23, 24, 25, 26, 27, 28, 29, 30, 35, 40, 50, 75, 100, 150, 200, 300,
400, 500, to one base shorter in length than the template sequence
at the 3' end of the primer to allow extension of a nucleic acid
chain, though the 5' end of the primer may extend in length beyond
the 3' end of the template sequence. In certain embodiments,
primers can be large polynucleotides, such as from about 35
nucleotides to several kilobases or more. Primers can be selected
to be "substantially complementary" to the sequence on the template
to which it is designed to hybridize and serve as a site for the
initiation of synthesis. By "substantially complementary", it is
meant that the primer is sufficiently complementary to hybridize
with a target polynucleotide. Desirably, the primer contains no
mismatches with the template to which it is designed to hybridize
but this is not essential. For example, non-complementary
nucleotide residues can be attached to the 5' end of the primer,
with the remainder of the primer sequence being complementary to
the template. Alternatively, non-complementary nucleotide residues
or a stretch of non-complementary nucleotide residues can be
interspersed into a primer, provided that the primer sequence has
sufficient complementarity with the sequence of the template to
hybridize therewith and thereby form a template for synthesis of
the extension product of the primer.
[1041] Also contemplated are biochip-based technologies such as
those described by Hacia et al. (1996, Nature Genetics 14: 441-447)
and Shoemaker et al. (1996, Nature Genetics 14: 450-456). Briefly,
these techniques involve quantitative methods for analyzing large
numbers of genes rapidly and accurately. By tagging genes with
oligonucleotides or using fixed nucleic acid probe arrays, one can
employ biochip technology to segregate target molecules as
high-density arrays and screen these molecules on the basis of
hybridization. See also Pease et al. (1994, Proc. Natl. Acad. Sci.
U.S.A. 91: 5022-5026); Fodor et al. (1991, Science 251: 767-773).
Briefly, nucleic acid probes to IRS biomarker polynucleotides are
made and attached to biochips to be used in screening and
diagnostic methods, as outlined herein. The nucleic acid probes
attached to the biochip are designed to be substantially
complementary to specific expressed IRS biomarker nucleic acids,
i.e., the target sequence (either the target sequence of the sample
or to other probe sequences, for example in sandwich assays), such
that hybridization of the target sequence and the probes of the
present invention occur. This complementarity need not be perfect;
there may be any number of base pair mismatches, which will
interfere with hybridization between the target sequence and the
nucleic acid probes of the present invention. However, if the
number of mismatches is so great that no hybridization can occur
under even the least stringent of hybridization conditions, the
sequence is not a complementary target sequence. In certain
embodiments, more than one probe per sequence is used, with either
overlapping probes or probes to different sections of the target
being used. That is, two, three, four or more probes, with three
being desirable, are used to build in a redundancy for a particular
target. The probes can be overlapping (i.e. have some sequence in
common), or separate.
[1042] In an illustrative biochip analysis, oligonucleotide probes
on the biochip are exposed to or contacted with a nucleic acid
sample suspected of containing one or more IRS biomarker
polynucleotides under conditions favoring specific hybridization.
Sample extracts of DNA or RNA, either single or double-stranded,
may be prepared from fluid suspensions of biological materials, or
by grinding biological materials, or following a cell lysis step
which includes, but is not limited to, lysis effected by treatment
with SDS (or other detergents), osmotic shock, guanidinium
isothiocyanate and lysozyme. Suitable DNA, which may be used in the
method of the invention, includes cDNA. Such DNA may be prepared by
any one of a number of commonly used protocols as for example
described in Ausubel, et al., 1994, supra, and Sambrook, et al.,
1989, supra.
[1043] Suitable RNA, which may be used in the method of the
invention, includes messenger RNA, complementary RNA transcribed
from DNA (cRNA) or genomic or subgenomic RNA. Such RNA may be
prepared using standard protocols as for example described in the
relevant sections of Ausubel, et al. 1994, supra and Sambrook, et
al. 1989, supra).
[1044] cDNA may be fragmented, for example, by sonication or by
treatment with restriction endonucleases. Suitably, cDNA is
fragmented such that resultant DNA fragments are of a length
greater than the length of the immobilized oligonucleotide probe(s)
but small enough to allow rapid access thereto under suitable
hybridization conditions. Alternatively, fragments of cDNA may be
selected and amplified using a suitable nucleotide amplification
technique, as described for example above, involving appropriate
random or specific primers.
[1045] Usually the target IRS biomarker polynucleotides are
detectably labeled so that their hybridization to individual probes
can be determined. The target polynucleotides are typically
detectably labeled with a reporter molecule illustrative examples
of which include chromogens, catalysts, enzymes, fluorochromes,
chemiluminescent molecules, bioluminescent molecules, lanthanide
ions (e.g., Eu.sup.34), a radioisotope and a direct visual label.
In the case of a direct visual label, use may be made of a
colloidal metallic or non-metallic particle, a dye particle, an
enzyme or a substrate, an organic polymer, a latex particle, a
liposome, or other vesicle containing a signal producing substance
and the like. Illustrative labels of this type include large
colloids, for example, metal colloids such as those from gold,
selenium, silver, tin and titanium oxide. In some embodiments in
which an enzyme is used as a direct visual label, biotinylated
bases are incorporated into a target polynucleotide.
[1046] The hybrid-forming step can be performed under suitable
conditions for hybridizing oligonucleotide probes to test nucleic
acid including DNA or RNA. In this regard, reference may be made,
for example, to NUCLEIC ACID HYBRIDIZATION, A PRACTICAL APPROACH
(Homes and Higgins, eds.) (IRL press, Washington D.C., 1985). In
general, whether hybridization takes place is influenced by the
length of the oligonucleotide probe and the polynucleotide sequence
under test, the pH, the temperature, the concentration of mono- and
divalent cations, the proportion of G and C nucleotides in the
hybrid-forming region, the viscosity of the medium and the possible
presence of denaturants. Such variables also influence the time
required for hybridization. The preferred conditions will therefore
depend upon the particular application. Such empirical conditions,
however, can be routinely determined without undue
experimentation.
[1047] After the hybrid-forming step, the probes are washed to
remove any unbound nucleic acid with a hybridization buffer. This
washing step leaves only bound target polynucleotides. The probes
are then examined to identify which probes have hybridized to a
target polynucleotide.
[1048] The hybridization reactions are then detected to determine
which of the probes has hybridized to a corresponding target
sequence. Depending on the nature of the reporter molecule
associated with a target polynucleotide, a signal may be
instrumentally detected by irradiating a fluorescent label with
light and detecting fluorescence in a fluorimeter; by providing for
an enzyme system to produce a dye which could be detected using a
spectrophotometer; or detection of a dye particle or a colored
colloidal metallic or non-metallic particle using a reflectometer;
in the case of using a radioactive label or chemiluminescent
molecule employing a radiation counter or autoradiography.
Accordingly, a detection means may be adapted to detect or scan
light associated with the label which light may include
fluorescent, luminescent, focused beam or laser light. In such a
case, a charge couple device (CCD) or a photocell can be used to
scan for emission of light from a probe:target polynucleotide
hybrid from each location in the micro-array and record the data
directly in a digital computer. In some cases, electronic detection
of the signal may not be necessary. For example, with enzymatically
generated color spots associated with nucleic acid array format,
visual examination of the array will allow interpretation of the
pattern on the array. In the case of a nucleic acid array, the
detection means is suitably interfaced with pattern recognition
software to convert the pattern of signals from the array into a
plain language genetic profile. In certain embodiments,
oligonucleotide probes specific for different IRS biomarker
polynucleotides are in the form of a nucleic acid array and
detection of a signal generated from a reporter molecule on the
array is performed using a `chip reader`. A detection system that
can be used by a `chip reader` is described for example by Pirrung
et al. (U.S. Pat. No. 5,143,854). The chip reader will typically
also incorporate some signal processing to determine whether the
signal at a particular array position or feature is a true positive
or maybe a spurious signal. Exemplary chip readers are described
for example by Fodor et al. (U.S. Pat. No. 5,925,525).
Alternatively, when the array is made using a mixture of
individually addressable kinds of labeled microbeads, the reaction
may be detected using flow cytometry.
[1049] In certain embodiments, the IRS biomarker is a target RNA
(e.g., mRNA) or a DNA copy of the target RNA whose level is
measured using at least one nucleic acid probe that hybridizes
under at least low, medium, or high stringency conditions to the
target RNA or to the DNA copy, wherein the nucleic acid probe
comprises at least 15 (e.g., 15, 16, 17, 18, 19, 20, 21, 22, 23,
24, 25, 26, 27, 28, 29, 30, or more) contiguous nucleotides of an
IRS biomarker polynucleotide. In some embodiments, the measured
level or abundance of the target RNA or its DNA copy is normalized
to the level or abundance of a reference RNA or a DNA copy of the
reference RNA. Suitably, the nucleic acid probe is immobilized on a
solid or semi-solid support. In illustrative examples of this type,
the nucleic acid probe forms part of a spatial array of nucleic
acid probes. In some embodiments, the level of nucleic acid probe
that is bound to the target RNA or to the DNA copy is measured by
hybridization (e.g., using a nucleic acid array). In other
embodiments, the level of nucleic acid probe that is bound to the
target RNA or to the DNA copy is measured by nucleic acid
amplification (e.g., using a polymerase chain reaction (PCR)). In
still other embodiments, the level of nucleic acid probe that is
bound to the target RNA or to the DNA copy is measured by nuclease
protection assay.
[1050] In other embodiments, IRS biomarker protein levels are
assayed using protein-based assays known in the art. For example,
when an IRS biomarker protein is an enzyme, the protein can be
quantified based upon its catalytic activity or based upon the
number of molecules of the protein contained in a sample.
Antibody-based techniques may be employed including, for example,
immunoassays, such as the enzyme-linked immunosorbent assay (ELISA)
and the radioimmunoassay (RIA).
[1051] In specific embodiments, protein-capture arrays that permit
simultaneous detection and/or quantification of a large number of
proteins are employed. For example, low-density protein arrays on
filter membranes, such as the universal protein array system (Ge,
2000 Nucleic Acids Res. 28(2):e3) allow imaging of arrayed antigens
using standard ELISA techniques and a scanning charge-coupled
device (CCD) detector Immuno-sensor arrays have also been developed
that enable the simultaneous detection of clinical analytes. It is
now possible using protein arrays, to profile protein expression in
bodily fluids, such as in sera of healthy or diseased subjects, as
well as in subjects pre- and post-drug treatment.
[1052] Exemplary protein capture arrays include arrays comprising
spatially addressed antigen-binding molecules, commonly referred to
as antibody arrays, which can facilitate extensive parallel
analysis of numerous proteins defining a proteome or subproteome.
Antibody arrays have been shown to have the required properties of
specificity and acceptable background, and some are available
commercially (e.g., BD Biosciences, Clontech, Bio-Rad and Sigma).
Various methods for the preparation of antibody arrays have been
reported (see, e.g., Lopez et al., 2003 J. Chromatogram. B
787:19-27; Cahill, 2000 Trends in Biotechnology 7:47-51; U.S. Pat.
App. Pub. 2002/0055186; U.S. Pat. App. Pub. 2003/0003599; PCT
publication WO 03/062444; PCT publication WO 03/077851; PCT
publication WO 02/59601; PCT publication WO 02/39120; PCT
publication WO 01/79849; PCT publication WO 99/39210). The
antigen-binding molecules of such arrays may recognize at least a
subset of proteins expressed by a cell or population of cells,
illustrative examples of which include growth factor receptors,
hormone receptors, neurotransmitter receptors, catecholamine
receptors, amino acid derivative receptors, cytokine receptors,
extracellular matrix receptors, antibodies, lectins, cytokines,
serpins, proteases, kinases, phosphatases, ras-like GTPases,
hydrolases, steroid hormone receptors, transcription factors,
heat-shock transcription factors, DNA-binding proteins, zinc-finger
proteins, leucine-zipper proteins, homeodomain proteins,
intracellular signal transduction modulators and effectors,
apoptosis-related factors, DNA synthesis factors, DNA repair
factors, DNA recombination factors and cell-surface antigens.
[1053] Individual spatially distinct protein-capture agents are
typically attached to a support surface, which is generally planar
or contoured. Common physical supports include glass slides,
silicon, microwells, nitrocellulose or PVDF membranes, and magnetic
and other microbeads.
[1054] Particles in suspension can also be used as the basis of
arrays, providing they are coded for identification; systems
include color coding for microbeads (e.g., available from Luminex,
Bio-Rad and Nanomics Biosystems) and semiconductor nanocrystals
(e.g., QDots.TM., available from Quantum Dots), and barcoding for
beads (UltraPlex.TM., available from Smartbeads) and multimetal
microrods (Nanobarcodes.TM. particles, available from Surromed).
Beads can also be assembled into planar arrays on semiconductor
chips (e.g., available from LEAPS technology and BioArray
Solutions). Where particles are used, individual protein-capture
agents are typically attached to an individual particle to provide
the spatial definition or separation of the array. The particles
may then be assayed separately, but in parallel, in a
compartmentalized way, for example in the wells of a microtiter
plate or in separate test tubes.
[1055] In operation, a protein sample, which is optionally
fragmented to form peptide fragments (see, e.g., U.S. Pat. App.
Pub. 2002/0055186), is delivered to a protein-capture array under
conditions suitable for protein or peptide binding, and the array
is washed to remove unbound or non-specifically bound components of
the sample from the array. Next, the presence or amount of protein
or peptide bound to each feature of the array is detected using a
suitable detection system. The amount of protein bound to a feature
of the array may be determined relative to the amount of a second
protein bound to a second feature of the array. In certain
embodiments, the amount of the second protein in the sample is
already known or known to be invariant.
[1056] In specific embodiments, the IRS biomarker is a target
polypeptide whose level is measured using at least one
antigen-binding molecule that is immuno-interactive with the target
polypeptide. In these embodiments, the measured level of the target
polypeptide is normalized to the level of a reference polypeptide.
Suitably, the antigen-binding molecule is immobilized on a solid or
semi-solid support. In illustrative examples of this type, the
antigen-binding molecule forms part of a spatial array of
antigen-binding molecule. In some embodiments, the level of
antigen-binding molecule that is bound to the target polypeptide is
measured by immunoassay (e.g., using an ELISA). Reference herein to
"immuno-interactive" includes reference to any interaction,
reaction, or other form of association between molecules and in
particular where one of the molecules is, or mimics, a component of
the immune system.
[1057] All the essential reagents required for detecting and
quantifying the biomarkers of the invention, including IRS
biomarkers, may be assembled together in a kit. In some
embodiments, the kit comprises: (i) a reagent that allows
quantification (e.g., determining the level or abundance) of a
first biomarker; and (ii) a reagent that allows quantification
(e.g., determining the level or abundance) of a second biomarker,
wherein the first and second biomarkers have a mutual correlation
in respect of at least one condition (e.g., at least one of a
healthy condition and one or more diseases such as but not limited
to inSIRS, ipSIRS or a stage of ipSIRS (e.g., a stage of ipSIRS
with a particular severity such as mild sepsis, severe sepsis and
septic shock)) that lies within a mutual correlation range of
between .+-.0.9, and wherein a combination of respective biomarker
values for the first and second biomarkers that are measured for or
derived from a biological subject has a performance value greater
than or equal to a performance threshold representing the ability
of the combination of the first and second biomarkers to diagnose
the presence, absence or degree of the at least one condition, or
to provide a prognosis for the at least one condition, the
performance threshold being a variance explained of at least 0.3.
In some embodiments, the kit further comprises (iii) a reagent that
allows quantification (e.g., determining the level or abundance) of
a third biomarker; and (iv) a reagent that allows quantification
(e.g., determining the level or abundance) of a fourth biomarker,
wherein the third and fourth biomarkers have a mutual correlation
in respect of at the least one condition that lies within a mutual
correlation range of between .+-.0.9, and wherein a combination of
respective biomarker values for the third and fourth biomarkers
that are measured for or derived from a biological subject has a
performance value greater than or equal to a performance threshold
representing the ability of the combination of the third and fourth
biomarkers to diagnose the presence, absence or degree of the at
least one condition, or to provide a prognosis for the at least one
condition, the performance threshold being a variance explained of
at least 0.3.
[1058] In advantageous embodiments, the kits of the present
invention are useful for diagnosing the presence, absence or degree
of at least one condition, or for providing a prognosis for at
least one condition, wherein the at least one condition is selected
from a healthy condition, inSIRS, ipSIRS or a stage of ipSIRS. In
these embodiments, IRS biomarkers are suitably selected from a
group as broadly described above and elsewhere herein.
[1059] In the context of the present invention, "kit" is understood
to mean a product containing the different reagents necessary for
carrying out the methods of the invention packed so as to allow
their transport and storage. Materials suitable for packing the
components of the kit include crystal, plastic (polyethylene,
polypropylene, polycarbonate and the like), bottles, vials, paper,
envelopes and the like. Additionally, the kits of the invention can
contain instructions for the simultaneous, sequential or separate
use of the different components contained in the kit. The
instructions can be in the form of printed material or in the form
of an electronic support capable of storing instructions such that
they can be read by a subject, such as electronic storage media
(magnetic disks, tapes and the like), optical media (CD-ROM, DVD)
and the like. Alternatively or in addition, the media can contain
Internet addresses that provide the instructions.
[1060] A "reagent that allows quantification of a biomarker" means
a compound or material, or set of compounds or materials, which
allow quantification of the biomarker. In specific embodiments, the
compound, material or set of compounds or materials permit
determining the expression level of a gene (e.g., an IRS biomarker
gene), including without limitation the extraction of RNA material,
the determination of the level of a corresponding RNA, etc.,
primers for the synthesis of a corresponding cDNA, primers for
amplification of DNA, and/or probes capable of specifically
hybridizing with the RNAs (or the corresponding cDNAs) encoded by
the genes, TaqMan probes, etc.
[1061] The kits may also optionally include appropriate reagents
for detection of labels, positive and negative controls, washing
solutions, blotting membranes, microtiter plates, dilution buffers
and the like. For example, a nucleic acid-based detection kit may
include (i) a biomarker polynucleotide (e.g., an IRS biomarker
polynucleotide) (which may be used as a positive control), (ii) a
primer or probe that specifically hybridizes to a biomarker
polynucleotide (e.g., an IRS biomarker polynucleotide). Also
included may be enzymes suitable for amplifying nucleic acids
including various polymerases (reverse transcriptase, Taq,
Sequenase.TM., DNA ligase etc. depending on the nucleic acid
amplification technique employed), deoxynucleotides and buffers to
provide the necessary reaction mixture for amplification. Such kits
also generally will comprise, in suitable means, distinct
containers for each individual reagent and enzyme as well as for
each primer or probe. Alternatively, a protein-based detection kit
may include (i) a biomarker polypeptide (e.g., an IRS biomarker
polypeptide) (which may be used as a positive control), (ii) an
antibody that binds specifically to a biomarker polypeptide (e.g.,
an IRS biomarker polypeptide). The kit can also feature various
devices (e.g., one or more) and reagents (e.g., one or more) for
performing one of the assays described herein; and/or printed
instructions for using the kit to quantify the expression of a
biomarker gene (e.g., an IRS biomarker gene).
[1062] The reagents described herein, which may be optionally
associated with detectable labels, can be presented in the format
of a microfluidics card, a chip or chamber, a microarray or a kit
adapted for use with the assays described in the examples or below,
e.g., RT-PCR or Q PCR techniques described herein. The term
"microarray" refers to an arrangement of hybridizable array
elements, e.g., probes (including primers), ligands, biomarker
nucleic acid sequence or protein sequences on a substrate.
[1063] The reagents also have utility in compositions for detecting
and quantifying the biomarkers of the invention. For example, a
reverse transcriptase may be used to reverse transcribe RNA
transcripts, including mRNA, in a nucleic acid sample, to produce
reverse transcribed transcripts, including reverse transcribed mRNA
(also referred to as "cDNA"). The nucleic acid sample is suitably
derived from components of the immune system, representative
examples of which include components of the innate and adaptive
immune systems as broadly discussed for example above. In specific
embodiments, the reverse transcribed RNA is derived blood cells
(e.g., peripheral blood cells). Suitably, the reverse transcribed
RNA is derived leukocytes.
[1064] The reagents are suitably used to quantify the reverse
transcribed transcripts. For example, oligonucleotide primers that
hybridize to the reverse transcribed transcript can be used to
amplify at least a portion of the reverse transcribed transcript
via a suitable nucleic acid amplification technique, e.g., RT-PCR
or Q PCR techniques described herein. Alternatively,
oligonucleotide probes may be used to hybridize to the reverse
transcribed transcript for the quantification, using a nucleic acid
hybridization analysis technique (e.g., microarray analysis), as
described for example above. Thus, in some embodiments, a
respective oligonucleotide primer or probe is hybridized to a
complementary nucleic acid sequence of a reverse transcribed
transcript in the compositions of the invention. The compositions
typically comprise labeled reagents for detecting and/or
quantifying the reverse transcribed transcripts. Representative
reagents of this type include labeled oligonucleotide primers or
probes that hybridize to RNA transcripts or reverse transcribed
RNA, labeled RNA, labeled reverse transcribed RNA as well as
labeled oligonucleotide linkers or tags (e.g., a labeled RNA or DNA
linker or tag) for labeling (e.g., end labeling such as 3' end
labeling) RNA or reverse transcribed RNA. The primers, probes, RNA
or reverse transcribed RNA (i.e., cDNA) (whether labeled or
non-labeled) may be immobilized or free in solution. Representative
reagents of this type include labeled oligonucleotide primers or
probes that hybridize to reverse transcribed and transcripts as
well as labeled reverse transcribed transcripts. The label can be
any reporter molecule as known in the art, illustrative examples of
which are described above and elsewhere herein.
[1065] The present invention also encompasses non-reverse
transcribed RNA embodiments in which cDNA is not made and the RNA
transcripts are directly the subject of the analysis. Thus, in
other embodiments, reagents are suitably used to quantify RNA
transcripts directly. For example, oligonucleotide probes can be
used to hybridize to transcripts for quantification of immune
system biomarkers of the invention, using a nucleic acid
hybridization analysis technique (e.g., microarray analysis), as
described for example above. Thus, in some embodiments, a
respective oligonucleotide probe is hybridized to a complementary
nucleic acid sequence of an immune system biomarker transcript in
the compositions of the invention. In illustrative examples of this
type, the compositions may comprise labeled reagents that hybridize
to transcripts for detecting and/or quantifying the transcripts.
Representative reagents of this type include labeled
oligonucleotide probes that hybridize to transcripts as well as
labeled transcripts. The primers or probes may be immobilized or
free in solution.
[1066] The term "immobilized" means that a molecular species of
interest is fixed to a solid support, suitably by covalent linkage.
This covalent linkage can be achieved by different means depending
on the molecular nature of the molecular species. Moreover, the
molecular species may be also fixed on the solid support by
electrostatic forces, hydrophobic or hydrophilic interactions or
Van-der-Waals forces. The above described physico-chemical
interactions typically occur in interactions between molecules. In
particular embodiments, all that is required is that the molecules
(e.g., nucleic acids or polypeptides) remain immobilized or
attached to a support under conditions in which it is intended to
use the support, for example in applications requiring nucleic acid
amplification and/or sequencing or in in antibody-binding assays.
For example, oligonucleotides or primers are immobilized such that
a 3' end is available for enzymatic extension and/or at least a
portion of the sequence is capable of hybridizing to a
complementary sequence. In some embodiments, immobilization can
occur via hybridization to a surface attached primer, in which case
the immobilized primer or oligonucleotide may be in the 3'-5'
orientation. In other embodiments, immobilization can occur by
means other than base-pairing hybridization, such as the covalent
attachment.
[1067] The term "solid support" as used herein refers to a solid
inert surface or body to which a molecular species, such as a
nucleic acid and polypeptides can be immobilized. Non-limiting
examples of solid supports include glass surfaces, plastic
surfaces, latex, dextran, polystyrene surfaces, polypropylene
surfaces, polyacrylamide gels, gold surfaces, and silicon wafers.
In some embodiments, the solid supports are in the form of
membranes, chips or particles. For example, the solid support may
be a glass surface (e.g., a planar surface of a flow cell channel).
In some embodiments, the solid support may comprise an inert
substrate or matrix which has been "functionalized", such as by
applying a layer or coating of an intermediate material comprising
reactive groups which permit covalent attachment to molecules such
as polynucleotides. By way of non-limiting example, such supports
can include polyacrylamide hydrogels supported on an inert
substrate such as glass. The molecules (e.g., polynucleotides) can
be directly covalently attached to the intermediate material (e.g.,
a hydrogel) but the intermediate material can itself be
non-covalently attached to the substrate or matrix (e.g., a glass
substrate). The support can include a plurality of particles or
beads each having a different attached molecular species.
[1068] The present invention also extends to the management of
inSIRS, ipSIRS or particular stages of ipSIRS, or prevention of
further progression of inSIRS, ipSIRS or particular stages of
ipSIRS (e.g., mild sepsis, severe sepsis and septic shock), or
assessment of the efficacy of therapies in subjects following
positive diagnosis for the presence of inSIRS, ipSIRS or particular
stage of ipSIRS (e.g., mild sepsis, severe sepsis and septic shock)
in a subject. The management of inSIRS or ipSIRS conditions is
generally highly intensive and can include identification and
amelioration of the underlying cause and aggressive use of
therapeutic compounds such as, vasoactive compounds, antibiotics,
steroids, antibodies to endotoxin, anti-tumor necrosis factor
agents, recombinant protein C. In addition, palliative therapies as
described for example in Cohen and Glauser (1991, Lancet 338:
736-739) aimed at restoring and protecting organ function can be
used such as intravenous fluids and oxygen and tight glycemic
control. Therapies for ipSIRS are reviewed in Healy (2002, Ann
Pharmacother. 36(4): 648-54) and Brindley (2005, CJEM. 7(4): 227)
and Jenkins (2006, J Hosp Med. 1(5): 285-295).
[1069] Typically, the therapeutic agents will be administered in
pharmaceutical (or veterinary) compositions together with a
pharmaceutically acceptable carrier and in an effective amount to
achieve their intended purpose. The dose of active compounds
administered to a subject should be sufficient to achieve a
beneficial response in the subject over time such as a reduction
in, or relief from, the symptoms of inSIRS, ipSIRS or particular
stages of ipSIRS. The quantity of the pharmaceutically active
compounds(s) to be administered may depend on the subject to be
treated inclusive of the age, sex, weight and general health
condition thereof. In this regard, precise amounts of the active
compound(s) for administration will depend on the judgment of the
practitioner. In determining the effective amount of the active
compound(s) to be administered in the treatment or prevention of
inSIRS, ipSIRS or particular stages of ipSIRS, the medical
practitioner or veterinarian may evaluate severity of any symptom
associated with the presence of inSIRS, ipSIRS or particular stages
of ipSIRS including, inflammation, blood pressure anomaly,
tachycardia, tachypnea fever, chills, vomiting, diarrhea, skin
rash, headaches, confusion, muscle aches, seizures. In any event,
those of skill in the art may readily determine suitable dosages of
the therapeutic agents and suitable treatment regimens without
undue experimentation.
[1070] The therapeutic agents may be administered in concert with
adjunctive (palliative) therapies to increase oxygen supply to
major organs, increase blood flow to major organs and/or to reduce
the inflammatory response. Illustrative examples of such adjunctive
therapies include non-steroidal-anti-inflammatory drugs (NSAIDs),
intravenous saline and oxygen.
[1071] In specific embodiments of the present invention, the
methods, apparatus and kits described above and elsewhere herein
are contemplated for use in methods of treating, preventing or
inhibiting the development of at least one condition selected from
inSIRS, ipSIRS or a particular stage of ipSIRS (e.g., mild sepsis,
severe sepsis or septic shock) in a subject. These methods (also
referred to herein as "treatment methods") generally comprise: (a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS biomarker of
a biological subject; (b) determining an indicator using a
combination of the plurality of IRS biomarker values, the indicator
being at least partially indicative of the presence, absence or
degree of the at least one condition, wherein: (i) at least two
(e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS biomarkers have a
mutual correlation in respect of the at least one condition that
lies within a mutual correlation range, the mutual correlation
range being between .+-.0.9; and (ii) the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence or degree of the at least one condition, the performance
threshold being indicative of an explained variance of at least
0.3; and (c) administering to the subject, on the basis that the
indicator indicates the presence of inSIRS, an effective amount of
an agent that treats or ameliorates the symptoms or reverses or
inhibits the development of inSIRS, or administering to the
subject, on the basis that the indicator indicates the presence of
ipSIRS or a particular stage of ipSIRS, an effective amount of an
agent that treats or ameliorates the symptoms or reverses or
inhibits the development of ipSIRS or the particular stage of
ipSIRS.
[1072] In advantageous embodiments, the treatment methods comprise:
(1) determining a plurality of measured IRS biomarker values, each
measured IRS biomarker value being a measured value of an IRS
biomarker of the biological subject; and (2) applying a function to
at least one of the measured IRS biomarker values to determine at
least one derived IRS biomarker value, the at least one derived IRS
biomarker value being indicative of a value of a corresponding
derived IRS biomarker. The function suitably includes at least one
of: (a) multiplying two IRS biomarker values; (b) dividing two IRS
biomarker values; (c) adding two IRS biomarker values; (d)
subtracting two IRS biomarker values; (e) a weighted sum of at
least two IRS biomarker values; (f) a log sum of at least two IRS
biomarker values; and (g) a sigmoidal function of at least two IRS
biomarker values.
[1073] In some embodiments the methods, apparatus and kits of the
present invention are used for monitoring, treatment and management
of conditions that can lead to inSIRS or ipSIRS, illustrative
examples of which include retained placenta, meningitis,
endometriosis, shock, toxic shock (i.e., sequelae to tampon use),
gastroenteritis, appendicitis, ulcerative colitis, Crohn's disease,
inflammatory bowel disease, acid gut syndrome, liver failure and
cirrhosis, failure of colostrum transfer in neonates, ischemia (in
any organ), bacteremia, infections within body cavities such as the
peritoneal, pericardial, thecal, and pleural cavities, burns,
severe wounds, excessive exercise or stress, hemodialysis,
conditions involving intolerable pain (e.g., pancreatitis, kidney
stones), surgical operations, and non-healing lesions. In these
embodiments, the methods or kits of the present invention are
typically used at a frequency that is effective to monitor the
early development of inSIRS, ipSIRS or particular stages of ipSIRS,
to thereby enable early therapeutic intervention and treatment of
that condition. In illustrative examples, the diagnostic methods or
kits are used at least at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,
13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 or 24 hour intervals or
at least 1, 2, 3, 4, 5 or 6 day intervals, or at least weekly,
fortnightly or monthly.
[1074] The present invention can be practiced in the field of
predictive medicine for the purpose of diagnosis or monitoring the
presence or development of a condition selected from inSIRS, ipSIRS
or a particular stage of ipSIRS in a subject, and/or monitoring
response to therapy efficacy.
[1075] The biomarker signatures and corresponding indicators of the
present invention further enable determination of endpoints in
pharmacotranslational studies. For example, clinical trials can
take many months or even years to establish the pharmacological
parameters for a medicament to be used in treating or preventing
inSIRS, ipSIRS or a particular stage of ipSIRS (e.g., mild sepsis,
severe sepsis and septic shock). However, these parameters may be
associated with a biomarker signature and corresponding indicator
of a health state (e.g., a healthy condition). Hence, the clinical
trial can be expedited by selecting a treatment regimen (e.g.,
medicament and pharmaceutical parameters), which results in a
biomarker signature associated with a desired health state (e.g.,
healthy condition). This may be determined for example by: a)
determining a plurality of IRS biomarker values, each IRS biomarker
value being indicative of a value measured or derived for at least
one (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS biomarker of
a biological subject after treatment with a treatment regimen; (b)
determining an indicator using a combination of the plurality of
IRS biomarker values, the indicator being at least partially
indicative of the presence, absence or degree of at least one
condition selected from a healthy condition, inSIRS, ipSIRS or a
particular stage of ipSIRS, wherein: (i) at least two (e.g., 2, 3,
4, 5, 6, 7, 8, 9, 10, or more) IRS biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the indicator has a performance
value greater than or equal to a performance threshold representing
the ability of the indicator to diagnose the presence, absence or
degree of the at least one condition, or to provide a prognosis for
the at least one condition, the performance threshold being
indicative of an explained variance of at least 0.3, and (c)
determining that the treatment regimen is effective for changing
the health status of the subject to the desired health state (e.g.,
healthy condition) on the basis that the indicator indicates the
presence of a healthy condition or the presence of a condition of a
lower degree relative to the degree of the condition in the subject
before treatment with the treatment regimen. As used herein, the
term "degree" refers to the extent or stage of a condition. Thus,
for example, mild sepsis is a stage or degree of sepsis that is
lower than severe sepsis. Similarly, severe sepsis is a stage or
degree of sepsis that is lower than septic shock. Accordingly, this
aspect of the present invention advantageously provides methods of
monitoring the efficacy of a particular treatment regimen in a
subject (for example, in the context of a clinical trial) already
diagnosed with a condition selected from inSIRS, ipSIRS or a
particular stage of ipSIRS. These methods take advantage of
measured or derived IRS biomarker values that correlate with
treatment efficacy to determine, for example, whether measured or
derived IRS biomarker values of a subject undergoing treatment
partially or completely normalize during the course of or following
therapy or otherwise shows changes associated with responsiveness
to the therapy.
[1076] As used herein, the term "treatment regimen" refers to
prophylactic and/or therapeutic (i.e., after onset of a specified
condition) treatments, unless the context specifically indicates
otherwise. The term "treatment regimen" encompasses natural
substances and pharmaceutical agents (i.e., "drugs") as well as any
other treatment regimen including but not limited to dietary
treatments, physical therapy or exercise regimens, surgical
interventions, and combinations thereof.
[1077] Accordingly, the invention provides methods of correlating a
biomarker signature with an effective treatment regimen for a
condition selected from inSIRS, ipSIRS or a particular stage of
ipSIRS (e.g., mild sepsis, severe sepsis and septic shock), wherein
the methods generally comprise: (a) determining a biomarker
signature defining a combination of at least two (e.g., 2, 3, 4, 5,
6, 7, 8, 9, 10, or more) IRS biomarker values corresponding to
values of at least two IRS biomarkers that can be measured for or
derived from a biological subject having the condition and for whom
an effective treatment has been identified, wherein: (i) the at
least two IRS biomarkers have a mutual correlation in respect of
the condition that lies within a mutual correlation range, the
mutual correlation range being between .+-.0.9; and (ii) the
combination of at least two biomarker values has a performance
value greater than or equal to a performance threshold representing
the ability of the combination of at least two biomarker values to
diagnose the presence, absence or degree of the condition, or to
provide a prognosis for the condition, the performance threshold
being indicative of an explained variance of at least 0.3; and (b)
correlating the biomarker signature so determined with an effective
treatment regimen for the condition. The term "correlating"
generally refers to determining a relationship between one type of
data with another or with a state. In specific embodiments, an
indicator or biomarker signature is correlated to a global
probability or a particular outcome, using receiver operating
characteristic (ROC) curves.
[1078] The invention further provides methods of determining
whether a treatment regimen is effective for treating a subject
with a condition selected from inSIRS, ipSIRS or a particular stage
of ipSIRS (e.g., mild sepsis, severe sepsis and septic shock).
These methods generally comprise: (a) determining a plurality of
post-treatment IRS biomarker values, each post-treatment IRS
biomarker value being indicative of a value measured or derived for
at least one (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS
biomarker of a biological subject after treatment with the
treatment regimen; (b) determining a post-treatment indicator using
a combination of the plurality of post-treatment IRS biomarker
values, the post-treatment indicator being at least partially
indicative of the presence, absence or degree of at least one
condition selected from a healthy condition, inSIRS, ipSIRS or a
particular stage of ipSIRS, wherein: (i) at the least two (e.g., 2,
3, 4, 5, 6, 7, 8, 9, 10, or more) IRS biomarkers have a mutual
correlation in respect of the at least one condition that lies
within a mutual correlation range, the mutual correlation range
being between .+-.0.9; and (ii) the post-treatment indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the post-treatment indicator to
diagnose the presence, absence or degree of the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3, wherein the post-treatment
indicator indicates whether the treatment regimen is effective for
treating the condition in the subject on the basis that
post-treatment indicator indicates the presence of a healthy
condition or the presence of a condition of a lower degree relative
to the degree of the condition in the subject before treatment with
the treatment regimen.
[1079] The invention can also be practiced to evaluate whether a
subject is responding (i.e., a positive response) or not responding
(i.e., a negative response) to a treatment regimen or has a side
effect to a treatment regimen. This aspect of the invention
provides methods of correlating a biomarker signature with a
positive or negative response or a side effect to a treatment
regimen, which generally comprise: (a) determining a biomarker
signature defining a combination of at least two (e.g., 2, 3, 4, 5,
6, 7, 8, 9, 10, or more) IRS biomarker values corresponding to
values of at least two IRS biomarkers that can be measured for or
derived from a biological subject following commencement of the
treatment regimen, wherein: (i) the at least two IRS biomarkers
have a mutual correlation in respect of at least one condition
selected from a healthy condition, inSIRS, ipSIRS or a particular
stage of ipSIRS, which lies within a mutual correlation range, the
mutual correlation range being between .+-.0.9; and (ii) the
combination of at least two biomarker values has a performance
value greater than or equal to a performance threshold representing
the ability of the combination of at least two biomarker values to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3; and (b) correlating the
biomarker signature so determined with a positive or negative
response to the treatment regimen. As used herein, the term
"positive response" means that the result of the treatment regimen
includes some clinically significant benefit, such as the
prevention, or reduction of severity, of symptoms, or a slowing of
the progression of the condition. By contrast, the term "negative
response" means that the treatment regimen provides no clinically
significant benefit, such as the prevention, or reduction of
severity, of symptoms, or increases the rate of progression of the
condition.
[1080] The invention also encompasses methods of determining a
positive or negative response to a treatment regimen and/or a side
effect of a treatment regimen by a subject with a condition
selected from inSIRS, ipSIRS or a particular stage of ipSIRS. These
methods generally comprise: (a) correlating a reference biomarker
signature with a positive or negative response or a side effect to
the treatment regimen, wherein the biomarker signature defines a
combination of at least two (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or
more) IRS biomarker values corresponding to values of at least two
IRS biomarkers that are measured for or derived from a control
biological subject or control group, wherein: (i) the at least two
IRS biomarkers have a mutual correlation in respect of at least one
condition selected from a healthy condition, inSIRS, ipSIRS or a
particular stage of ipSIRS, which lies within a mutual correlation
range, the mutual correlation range being between .+-.0.9; and (ii)
the combination of at least two biomarker values has a performance
value greater than or equal to a performance threshold representing
the ability of the combination of at least two biomarker values to
diagnose the presence, absence or degree of the at least one
condition, or to provide a prognosis for the at least one
condition, the performance threshold being indicative of an
explained variance of at least 0.3; (b) determining a sample
biomarker signature defining a combination of at least two (e.g.,
2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS biomarker values
corresponding to values of at least two IRS biomarkers that are
measured for or derived from a biological subject following
commencement of the treatment regimen, wherein: (i) the at least
two IRS biomarkers have a mutual correlation in respect of at least
one condition selected from a healthy condition, inSIRS, ipSIRS or
a particular stage of ipSIRS, which lies within a mutual
correlation range, the mutual correlation range being between
.+-.0.9; and (ii) the combination of at least two biomarker values
has a performance value greater than or equal to a performance
threshold representing the ability of the combination of at least
two biomarker values to diagnose the presence, absence or degree of
the at least one condition, or to provide a prognosis for the at
least one condition, the performance threshold being indicative of
an explained variance of at least 0.3; wherein the sample biomarker
signature indicates whether the subject is responding positively or
negatively to the treatment regimen and/or is developing a side
effect from the treatment regimen, based on the correlation of the
reference biomarker signature with the positive or negative
response or side effect to the treatment regimen.
[1081] In related embodiments, the present invention further
contemplates methods of determining a positive or negative response
to a treatment regimen and/or a side effect to a treatment regimen
by a biological subject. These methods generally comprise: (a)
determining a sample biomarker signature defining a combination of
at least two (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) IRS
biomarker values corresponding to values of at least two IRS
biomarkers that are measured for or derived from a biological
subject following commencement of the treatment regimen, wherein:
(i) the at least two IRS biomarkers have a mutual correlation in
respect of at least one condition selected from a healthy
condition, inSIRS, ipSIRS or a particular stage of ipSIRS, which
lies within a mutual correlation range, the mutual correlation
range being between .+-.0.9; and (ii) the combination of at least
two biomarker values has a performance value greater than or equal
to a performance threshold representing the ability of the
combination of at least two biomarker values to diagnose the
presence, absence or degree of the at least one condition, or to
provide a prognosis for the at least one condition, the performance
threshold being indicative of an explained variance of at least
0.3, wherein the sample biomarker signature is correlated with a
positive or negative response to the treatment regimen and/or to a
side effect from the treatment regimen; and (b) determining whether
the subject is responding positively or negatively to the treatment
regimen and/or is developing a side effect from the treatment
regimen based on the sample biomarker signature.
[1082] This above methods can be practiced to identify responders
or non-responders relatively early in the treatment process, i.e.,
before clinical manifestations of efficacy. In this way, the
treatment regimen can optionally be discontinued, a different
treatment protocol can be implemented and/or supplemental therapy
can be administered. Thus, in some embodiments, a sample IRS
biomarker signature is obtained within about 2 hours, 4 hours, 6
hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 1 week, 2
weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 4
months, six months or longer of commencing therapy.
[1083] A number of non-limiting example signatures for use in
diagnosing respective conditions will now be described. For the
purpose of illustration, the above-described process was used to
select biomarkers that provided the theoretical best diagnostic
biomarkers, selected from combinations including measured and/or
derived biomarkers. Following this, other measured and/or derived
biomarkers were grouped based on their correlation to the best
diagnostic biomarkers, with the ability of biomarkers within these
groups to act as a diagnostic signature then being assessed.
[1084] The results set out in detail below highlight that as long
as the above-described criteria are met, the resulting signatures
provide the required discriminatory ability for use in diagnosing
the presence, absence, degree or prognosis of at least one
condition in a biological subject.
Signature Derivation
[1085] An illustrative process for the identification of mRNA
biomarkers for use in diagnostic algorithms will now be
described.
Summary
[1086] Peripheral blood samples were obtained from healthy controls
and patients retrospectively diagnosed by a panel of physicians
with either inSIRS or ipSIRS (blood culture positive). ipSIRS
patients were further classified retrospectively into "mild",
"severe" or "shock" based on clinical parameters. Total RNA from
patient samples was then used in gene expression analysis
(GeneChip.RTM. and/or quantitative PCR (qPCR)). Gene expression
data were analyzed using a variety of statistical approaches to
identify individual and derived markers. Derived markers were
divided into groups based on how they correlated to each of the
markers in the top-performing (based on AUC) ratio. This ratio
approach provides the best diagnostic power with respect to AUC for
separating: healthy and post-surgical (PS) (also referred to herein
as "inSIRS") conditions; healthy and sepsis (also referred to
herein as "ipSIRS"); inSIRS and ipSIRS; mild ipSIRS and severe
ipSIRS; mild ipSIRS and septic shock; and severe ipSIRS and septic
shock.
Clinical Trials
[1087] Clinical trials were performed to determine whether certain
mRNA transcripts could distinguish between healthy controls and
various patient groups and within patient groups. Intensive care
sepsis, post-surgical and inSIRS patients, as well as healthy
controls were prospectively enrolled and attended a single visit
where blood was collected for gene expression and mRNA analyses
using Affymetrix exon arrays and/or quantitative real-time PCR
(qRT-PCR). A definitive diagnosis of infection-positive SIRS (mild,
severe or shock) or inSIRS was unlikely to be known at the time
patients were enrolled, and thus confirmation of a diagnosis and
the assignment of patients to the cohorts were made
retrospectively.
[1088] Patients who had clinical signs and/or symptoms of ipSIRS or
inSIRS were consented and enrolled into the study as soon as
possible after they had been identified, in most cases within 24
hours of admission. Final assessment of whether the participant had
inSIRS, ipSIRS (mild, severe, or shock) was made retrospectively as
clinical information and blood culture results became
available.
[1089] Study participants were all over 18 years and either they or
their surrogate decision maker signed and dated the clinical trial
information sheet and consent form. All of the control participants
were considered to be in good health based on a brief physical
examination and their medical history at the time of enrolment.
[1090] Patients or their surrogate decision maker were offered the
opportunity to participate in this study if the patient presented
with signs and symptoms of either inSIRS or ipSIRS at the time of
admission to ICU (using criteria based on the American College of
Physicians and the Society of Critical Care Medicine standard
definitions). That is, inSIRS and ipSIRS participants needed a
variable combination of clinical conditions including two or more
of the following within the last 24 hours: temperature
>38.degree. C. or <36.degree. C.; heart rate >90
beats/min; respiratory rate >20 breathes/min or a PaCO.sub.2 of
<4.3 kPa (<32 mm Hg); and evidence of a white blood cell
count <4,000 cells/mm.sup.3 (<4.times.10.sup.9 cells/L) or
>12,000 cells/mm.sup.3 (>12.times.10.sup.9 cells/L) or
>10% immature neutrophils (band forms). Participants were
excluded if they had any chronic systemic immune-inflammatory
disorders including SLE, Crohn's disease, insulin-dependent
diabetes mellitus (IDDM); were transplant recipients or were
currently receiving chemotherapy treatment for cancer. Most
patients had other underlying co-morbidities. All study
participants were 18 years of age or older and had a body mass
index of less than 40.
[1091] Demography, vital signs measurements (blood pressure, heart
rate, respiratory rate, oxygen saturation, temperature), hematology
(full blood count), clinical chemistry (urea, electrolytes, liver
function enzymes, blood glucose) as well as microbial status was
recorded.
[1092] Blood was collected for the purpose of extraction of high
quality RNA into PAXgene.TM. tubes (PreAnalytix Inc., Valencia,
Calif., USA). Blood for bacterial culture was collected into BacTec
Plus Aerobic (10 ml) and BacTec Plus Anaerobic (10 mL) tubes
(Becton Dickinson) tubes for the detection of aerobic and anaerobic
bacterial growth respectively.
[1093] A PAXgene blood RNA kit available from Qiagen Inc.
(Valencia, Calif., USA) was used to isolate total RNA from PAXgene
tubes. Isolation begins with a centrifugation step to pellet
nucleic acids in the PAXgene blood RNA tube. The pellet is washed
and re-suspended and incubated in optimized buffers together with
Proteinase K to bring about protein digestion. An additional
centrifugation is carried out to remove residual cell debris and
the supernatant is transferred to a fresh microcentrifuge tube.
Ethanol is added to adjust binding conditions, and the lysate is
applied to the PAXgene RNA spin column. During brief
centrifugation, RNA is selectively bound to the silica-gel membrane
as contaminants pass through. Remaining contaminants are removed in
three efficient wash steps and RNA is then eluted in Buffer BR5.
Determination of RNA quantity and quality was performed using an
Agilent Bioanalyzer and Absorbance 260/280 ratio using a
spectrophotometer.
Processing of Samples
[1094] Measurement of specific mRNA levels in a tissue sample can
be achieved using a variety of technologies. A common and readily
available technology that covers most of the known human mRNAs is
GeneChip.RTM. analysis using Affymetrix technology. Details on the
technology and methodology can be found at www.affymetrix.com.
GeneChip.RTM. analysis has the advantage of being able to analyze
thousands of RNA transcripts at a time. Another common and readily
available technology is qPCR (quantitative polymerase chain
reaction), which has the advantage of being able to analyze, in
real-time and quantitatively, hundreds of RNA transcripts at a
time. Details on one of these technologies (TaqMan.RTM.),
chemistries and methodologies can be found on the Life Technologies
website including published protocols entitled; "Protocol:
Introduction to TaqMan SYBR Green Chemistries for Real-Time PCR"
and "TaqMan Gene Expression Assays Protocol." Both GeneChip.RTM.
and qPCR were used in the discovery and proof-of-concept stages for
biomarker identification. qPCR was used exclusively for biomarker
feasibility testing.
Analysis, Interpretation of Data and Selection of Biomarkers and
Derived Biomarkers
[1095] Healthy Control Versus inSIRS
[1096] A list of 941 mRNA individual markers with an AUC of at
least 0.7 for separating the two conditions of Healthy and inSIRS
was generated. FIG. 8A plots these markers against the AUC and FIG.
8B is a box and whisker plot of the best mRNA biomarker for
separating the two conditions (AGFG1-ArfGAP with FG repeats 1). The
conditions of Healthy and inSIRS are perfectly separated when using
this mRNA biomarker alone.
[1097] From the 941 individual markers at least 1000 derived
markers (ratios) were generated that had an AUC of 1.0. A plot of
the AUC of these derived markers for separating the conditions of
Healthy and inSIRS is shown in FIG. 8C with the top performing
ratio shown as a box and whisker plot in FIG. 8D. The AUC for AGFG1
and PVRIG (poliovirus receptor related immunoglobulin domain
containing) has a ratio is 1.0.
[1098] All 941 individual markers were then broken into two
groups--those that correlate to AGFG1 and those that correlate to
PVRIG. FIGS. 8E and 8F demonstrate the correlation between the two
groups based on their similarity to either AGFG1 or PVRIG. In these
plots the groups are referred to as either group 1 (AGFG1) or group
2 (PVRIG). It can be seen that each "group" contains those markers
that are most highly correlated to each other.
[1099] The markers in each "group" also correlate strongly (as
demonstrated by AUC greater than 0.7 for all markers) to the
condition being studied (in this instance Healthy versus inSIRS
(PS)) as shown in FIGS. 8G and 8H.
[1100] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating Healthy and inSIRS is obtained
than when markers are chosen from within groups (p<2.558e-13) as
demonstrated in FIG. 8I, which shows a greater overall AUC is
obtained compared to when using markers from either group 1 or
group 2 alone. The mean AUC for markers derived from groups 1 and 2
is over 0.97, whereas the mean AUC for markers derived from either
group 1 or 2 alone is less than 0.9.
Healthy Control Versus ipSIRS
[1101] A list of 941 mRNA individual markers with an AUC of at
least 0.7 for separating the two conditions of Healthy and ipSIRS
was generated. FIG. 9A plots these markers against the AUC and FIG.
9B is a box and whisker plot of the best mRNA biomarker for
separating the two conditions (LTBP3--latent transforming growth
factor beta binding protein 3). The conditions of Healthy and
ipSIRS are perfectly separated when using this mRNA biomarker
alone.
[1102] From the 941 individual markers at least 1000 derived
markers (ratios) were generated that had an AUC of 1.0. A plot of
the AUC of these derived markers for separating the conditions of
Healthy and inSIRS is shown in FIG. 9C with the top performing
ratio shown as a box and whisker plot in FIG. 9D. The AUC for LTBP3
and LPHN1 (latrophilin 1) as a ratio is 1.0.
[1103] All 941 individual markers were then broken into two
groups--those that correlate to LTBP3 and those that correlate to
LPHN1. Both plots in FIGS. 9E and 9F demonstrate the correlation
between the two groups based on their similarity to either LTBP3 or
LPHN1. It can be seen that each "group" contains those markers that
are most highly correlated to each other.
[1104] The markers in each "group" also correlate strongly (as
demonstrated by AUC greater than 0.7 for all markers) to the
condition being studied (in this instance Healthy versus ipSIRS
(sepsis)), as shown in FIGS. 9G and 9H.
[1105] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating Healthy and ipSIRS is obtained
than when markers are chosen from within groups (p<2.2e-16) as
demonstrated in FIG. 9I, which shows an improved AUC compared to
using markers from either group 1 or group 2 alone. The mean AUC
for markers derived from groups 1 and 2 is over 0.97, whereas the
mean AUC for markers derived from either group 1 or 2 alone is less
than 0.8.
inSIRS Versus ipSIRS
[1106] A list of 359 mRNA individual markers with an AUC of at
least 0.7 for separating the two conditions of inSIRS and ipSIRS
was generated. FIG. 10A plots these markers against the AUC and
FIG. 10B is a box and whisker plot of the best mRNA biomarker for
separating the two conditions (PIWIL4--piwi-like RNA mediated gene
silencing 4). The conditions of inSIRS (PS) and ipSIRS (sepsis) are
well separated when using this mRNA biomarker alone.
[1107] From the 359 individual markers 1000 derived markers
(ratios) were generated that had an AUC greater than 0.9. A plot of
the AUC of these derived markers for separating the conditions of
inSIRS and ipSIRS is shown in FIG. 10C with the top performing
ratio of PLA2G7 (phospholipase A2, Group VII, (platelet activating
factor acetyl hydrolase, plasma)) and PLAC8 (placenta-specific 8)
shown as a box and whisker plot in FIG. 10D.
[1108] All 359 individual markers were then broken into two
groups--those that correlate to PLA2G7 and those that correlate to
PLAC8. The plot in FIG. 10E demonstrates that the markers in each
"group" correlate strongly (as demonstrated by AUC greater than 0.7
for all markers) to the condition being studied (in this instance
inSIRS (PS) versus ipSIRS (sepsis)).
[1109] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating inSIRS (PS) and ipSIRS (sepsis)
is obtained than when markers are chosen from within groups
(p<5.78e-5) as demonstrated in FIG. 10F compared to when using
markers from either group 1 or group 2 alone. The mean AUC for
markers derived from groups 1 and 2 is over 0.80, whereas the mean
AUC for markers derived from either group 1 or 2 alone is less than
0.8.
[1110] In an alternative embodiment, the markers were broken into
four groups--those that correlate to CEACAM4 (bucket 3), those that
correlate to LAMP1 (bucket 4), those that correlate to PLA2G7
(bucket 1) and those that correlate to PLAC8 (bucket 2). The plots
in FIG. 10G demonstrate the markers in each group correlate
strongly (as demonstrated by AUC greater than 0.7 for all markers)
to the condition being studied (i.e., inSIRS (PS) versus ipSIRS
(sepsis)). Like the two-bucket embodiment discussed above, choosing
mRNAs from four groups to create derived markers results in an
overall better AUC for separating inSIRS (PS) and ipSIRS (sepsis),
as compared to when markers are chosen from within groups
(p<0.2564, as demonstrated in FIG. 10H compared to when using
markers from any one of groups 1 to 4. The mean AUC for markers
derived from groups 1 to 4 is over 0.8 whereas the mean AUC for
markers derived from any one of groups 1 to 4 is less than 0.8
Mild ipSIRS Versus Severe ipSIRS
[1111] A list of 66 mRNA individual markers with an AUC of at least
0.7 for separating the two conditions of mild ipSIRS and severe
ipSIRS was generated. FIG. 11A plots these markers against the AUC
and FIG. 11B is a box and whisker plot of the best mRNA biomarker
for separating the two conditions (N4BP2L2-NEDD4 binding protein
2-like 2). The conditions of mild ipSIRS and severe ipSIRS are well
separated when using this mRNA biomarker alone.
[1112] From the 66 individual markers at least 1000 derived markers
(ratios) were generated that had an AUC of 0.87. A plot of the AUC
of these derived markers for separating the conditions of mild
ipSIRS and severe ipSIRS is shown in FIG. 11C with the top
performing ratio shown as a box and whisker plot in FIG. 11D. The
AUC for N4BP2L2 and ZC3H11A (zinc finger CCCH-type containing 11A)
as a ratio is 0.983.
[1113] All 66 individual markers were then broken into two
groups--those that correlate to N4BP2L2 and those that correlate to
ZC3H11A. Both plots in FIGS. 11E and 11F demonstrate the
correlation between the two groups based on their similarity to
either N4BP2L2 or ZC3H11A. In these plots the groups are referred
to as either group 1 (N4BP2L2) or group 2 (ZC3H11A). It can be seen
that each "group" contains those markers that are most highly
correlated to each other. The markers in each "group" also
correlate strongly (as demonstrated by AUC greater than 0.7 for all
markers) to the condition being studied (in this instance mild
ipSIRS versus severe ipSIRS).
[1114] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating mild ipSIRS and severe ipSIRS
is obtained than when markers are chosen from within groups
(p<2.2e-16) as demonstrated in FIG. 11I, compared to when using
markers from either group 1 or group 2 alone. The mean AUC for
markers derived from groups 1 and 2 is over 0.89, whereas the mean
AUC for markers derived from either group 1 or 2 alone is less than
0.6.
Mild ipSIRS Versus ipSIRS--Shock
[1115] A list of 48 mRNA individual markers with an AUC of at least
0.7 for separating the two conditions of mild ipSIRS and
ipSIRS--shock was generated. FIG. 12A plots these markers against
the AUC and FIG. 12B is a box and whisker plot of the best mRNA
biomarker for separating the two conditions (CD6-CD6 molecule). The
conditions of mild ipSIRS and ipSIRS shock are well separated when
using this mRNA biomarker alone.
[1116] From the 48 individual markers at least 1000 derived markers
(ratios) were generated that had an AUC of at least 0.793. A plot
of the AUC of these derived markers for separating the conditions
of mild ipSIRS and ipSIRS shock is shown in FIG. 12C with the top
performing ratio shown as a box and whisker plot in FIG. 12D. The
AUC for VAMP2 and UBAP1 (ubiquitin associated protein 1) as a ratio
is 0.978.
[1117] All 48 individual markers were then broken into two
groups--those that correlate to VAMP2 and those that correlate to
UBAP1. Both plots in FIGS. 12E and 12F demonstrate the correlation
between the two groups based on their similarity to either VAMP2 or
UBAP1. In these plots the groups are referred to as either group 1
(VAMP2) or group 2 (UBAP1). It can be seen that each "group"
contains those markers that are most highly correlated to each
other. The markers in each "group" also correlate strongly (as
demonstrated by AUC greater than 0.7 for all markers) to the
condition being studied (in this instance mild ipSIRS versus
ipSIRS--shock).
[1118] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating mild ipSIRS and ipSIRS--shock
is obtained than when markers are chosen from within groups
(p<2.2e-16) as demonstrated in FIG. 12I, compared to when using
markers from either group 1 or group 2 alone. The mean AUC for
markers derived from groups 1 and 2 is over 0.87, whereas the mean
AUC for markers derived from either group 1 or 2 alone is less than
0.65.
Severe ipSIRS Versus ipSIRS--Shock
[1119] A list of 61 mRNA individual markers with an AUC of at least
0.7 for separating the two conditions of severe ipSIRS and
ipSIRS--shock was generated. FIG. 13A plots these markers against
the AUC and FIG. 13B is a box and whisker plot of the best mRNA
biomarker for separating the two conditions (SIRPG--signal
regulatory protein gamma) The conditions of severe ipSIRS and
ipSIRS--shock are well separated when using this mRNA biomarker
alone.
[1120] From the 61 individual markers at least 1000 derived markers
(ratios) were generated that had an AUC of at least 0.821. A plot
of the AUC of these derived markers for separating the conditions
of severe ipSIRS and ipSIRS--shock is shown in FIG. 13C with the
top performing ratio shown as a box and whisker plot in FIG. 13D.
The AUC for GATA3 (GATA binding protein 3) and MECOM (MDS1 and EVI1
complex locus) as a ratio is 0.936.
[1121] All 61 individual markers were then broken into two
groups--those that correlate to GATA3 and those that correlate to
MECOM. Both plots in FIGS. 13E and 13F demonstrate the correlation
between the two groups based on their similarity to either GATA3 or
MECOM. In these plots the groups are referred to as either group 1
(GATA3) or group 2 (MECOM). It can be seen that each "group"
contains those markers that are most highly correlated to each
other. The markers in each "group" also correlate strongly (as
demonstrated by AUC greater than 0.7 for all markers) to the
condition being studied (in this instance severe ipSIRS versus
ipSIRS--shock).
[1122] By choosing mRNAs from these two groups to create derived
markers a better AUC for separating severe ipSIRS and ipSIRS--shock
is obtained than when markers are chosen from within groups
(p<2.2e-16) as demonstrated in FIG. 13I compared to when using
markers from either group 1 or group 2 alone. The mean AUC for
markers derived from groups 1 and 2 is over 0.82, whereas the mean
AUC for markers derived from either group 1 or 2 alone is less than
0.7.
Signature Usage
[1123] Use of the above described markers and resulting signatures
in patient populations and benefits in respect of differentiating
inSIRS and ipSIRS, will now be described.
[1124] An assay capable of differentiating patients with inSIRS and
ipSIRS can be used in multiple patient populations including:
1) Intensive Care Unit (medical and surgical ICU) 2) Post-surgical
and medical wards
3) Emergency Department
[1125] 4) Medical clinics.
[1126] Patients admitted to intensive care (ICU) often have ipSIRS,
or develop ipSIRS during their ICU stay. The ultimate aim of
intensive care is to ensure the patient survives and is discharged
to a general ward in the minimum time. Patients in intensive care
with diagnosed ipSIRS are usually administered a number of
therapeutic compounds--many of which have opposing actions on the
immune system and many of which could be counterproductive
depending on the severity of ipSIRS (mild sepsis, severe sepsis,
septic shock). Monitoring intensive care patients on a regular
basis with biomarkers of the present invention will allow medical
practitioners to differentiate inSIRS from ipSIRS and determine the
stage of ipSIRS and hence choice of therapies, when to start and
stop therapies, and patient management procedures, and ultimately
response to therapy. Information provided by these biomarkers will
therefore allow medical intensivists to tailor and modify therapies
to ensure patients survive and spend less time in intensive care.
Less time in intensive care leads to considerable savings in
medical expenses including through less occupancy time and
appropriate use and timing of medications.
[1127] Surgical and general medical patients often develop inSIRS
post-surgery or as a consequence of their condition or procedures
and have a higher risk of developing ipSIRS. Post-operative and
medical care in such patients therefore involves monitoring for
signs of inSIRS and ipSIRS and differentiating between these two
conditions. The treatment and management of inSIRS and ipSIRS
patients post-surgically and in general wards is different, since
inSIRS patients can be put on mild anti-inflammatory drugs or
anti-pyretics and ipSIRS patients must be started on antibiotics as
soon as possible for best outcomes. Monitoring post-surgical and
medical patients on a regular basis with biomarkers of the present
invention will allow nursing and medical practitioners to
differentiate inSIRS and ipSIRS at an early stage and hence make
informed decisions on choice of therapies and patient management
procedures, and ultimately response to therapy. Information
provided by these biomarkers will therefore allow medical
practitioners to tailor and modify therapies to ensure patients
recover quickly from surgery or other condition and do not develop
ipSIRS. Less time in hospital and less complications leads to
considerable savings in medical expenses including through less
occupancy time and appropriate use and timing of medications.
[1128] Further, patients presenting to emergency departments often
have a fever, which is one (of four) of the clinical signs of
inSIRS. Such patients need to be assessed to determine if they have
either inSIRS or ipSIRS. As mentioned above, the treatment and
management of pyretic, inSIRS and septic patients are different. By
way of example, a patient with a fever without other inSIRS
clinical signs and no obvious source of infection may be sent home,
or provided with other non-hospital services, without further
hospital treatment. However, a patient with a fever may have early
ipSIRS and not admitting such a patient may put their life at risk.
Because these biomarkers can differentiate inSIRS and ipSIRS they
will allow medical practitioners to triage emergency department
patients quickly and effectively. Accurate triage decision-making
insures that patients requiring hospital treatment are given it,
and those that don't are provided with other appropriate
services.
[1129] Further still, patients presenting to medical clinics often
have any one of the four clinical signs of inSIRS (increased heart
rate, increased respiratory rate, abnormal white blood cell count,
fever or hypothermia). Many different clinical conditions can
present with one of the four clinical signs of inSIRS and such
patients need to be assessed to determine if they have either
inSIRS or ipSIRS and to exclude other differential diagnoses. By
way of example, a patient with colic might also present with
clinical signs of increased heart rate. Differential diagnoses
could be (but not limited to) appendicitis, urolithiasis,
cholecystitis, pancreatitis, enterocolitis. In each of these
conditions it would be important to determine if there was a
systemic inflammatory response (inSIRS) or whether an infection was
contributing to the systemic response to the condition (ipSIRS).
The treatment and management of patients with and without systemic
inflammation and/or infection are different. Because these
biomarkers can differentiate patients with a systemic inflammatory
response to infection from those with a systemic inflammatory
response without infection (inSIRS and ipSIRS), and determine the
degree of systemic involvement, the use of them will allow medical
practitioners to determine the next medical procedure(s) to perform
to satisfactorily resolve the patient issue.
Determining the Extent of Systemic Inflammation in Sick Patients
and Those with inSIRS and ipSIRS
[1130] As mentioned above, patients presenting to medical clinics
often have any one of the four clinical signs of inSIRS. However,
many different clinical conditions can present with one of the four
clinical signs of inSIRS and such patients need to be assessed to
determine if they have inSIRS, and if so the extent of inSIRS, or
ipSIRS, and if so the extent of ipSIRS, and to exclude other
differential diagnoses.
[1131] By way of example, a patient with respiratory distress is
likely to present with clinical signs of increased respiratory
rate. Differential diagnoses could be (but not limited to) asthma,
pneumonia, congestive heart failure, physical blockage of airways,
allergic reaction, collapsed lung, pneumothorax. In each of these
conditions it would be important to determine if there was a
systemic inflammatory response (inSIRS) or whether an infection was
contributing to the condition. The treatment and management of
patients with and without systemic inflammation and/or infection
are different. Because these biomarkers can differentiate patients
with a systemic inflammatory response to infection from those with
a systemic inflammatory response without infection (inSIRS and
ipSIRS), and determine the degree of systemic involvement, the use
of them will allow medical practitioners to determine the next
medical procedure(s) to perform to satisfactorily resolve the
patient issue. Patients with a collapsed lung, pneumothorax or a
physical blockage are unlikely to have a large systemic
inflammatory response and patients with congestive heart failure,
allergic reaction or asthma are unlikely to have a large systemic
inflammatory response due to infection. The extent of both inSIRS
and ipSIRS, as indicated by biomarkers presented in this patent,
also provides clinicians with information on next treatment and
management steps. For example, a patient with respiratory distress
and a strong biomarker response indicating ipSIRS is likely to be
immediately hospitalized, placed on antibiotics and a chest X-ray
performed. A patient with respiratory distress and a strong
biomarker response indicating inSIRS but not ipSIRS is likely to be
hospitalized and chest X-rayed along with other investigative
diagnostic procedures, such as MRI, ECG, and angiogram. A patient
with respiratory distress with a short history and no inSIRS or
ipSIRS is likely to undergo further examination at a local clinic
rather than requiring hospitalization.
[1132] Again, and as mentioned above, patients presenting to
emergency departments often have a fever, which is one (of four) of
the clinical signs of inSIRS. Such patients need to be assessed to
determine if they have either inSIRS or ipSIRS. Further it is
important to determine how sick they are to be able to make a
Judgment call on whether to admit the patient or not. Accurate
triage decision-making insures that patients requiring hospital
treatment are given it, and those that don't are provided with
other appropriate services.
[1133] Patients in ICU often have inSIRS and ipSIRS and it is
important to differentiate these two conditions as treatment
regimens differ. In patients with inSIRS it is important to
determine the extent of the inflammatory response so that
appropriate treatments and management regimens can be put in place.
For example, a patient newly determined to have inSIRS that is not
extensive may be able to be put on mild medication such a
non-steroidal anti-inflammatory. A patient newly determined to have
extensive inSIRS (e.g. trauma) may require stronger
anti-inflammatory medication such as steroids to reduce the
potential impact of the side effects of inflammation (swelling). In
patients with ipSIRS it is also important to determine the extent
of the inflammatory response to infection so that appropriate
treatments and management regimens can be put in place or stopped.
For example, for a patient with a persistent strong ipSIRS response
the clinician may consider either changing, or adding to, the
antibiotic treatment regimen in the absence of traditional
bacterial culture and sensitivity results. Further, patients that
are known to have had ipSIRS and have been on antimicrobial therapy
for an extended period but have since demonstrated (by testing
using biomarkers) that they no longer have either an inSIRS or
ipSIRS can therefore be safely taken off intravenous
antibiotics.
Determining the Severity of ipSIRS
[1134] Patients admitted to intensive care (ICU) often have ipSIRS,
or develop ipSIRS during their ICU stay. It is known that the
severity of sepsis can be considered to be a continuum from less
severe, or sepsis, to more severe, or severe sepsis, to the most
severe, or septic shock. More severe sepsis (ipSIRS) requires more
aggressive, immediate and tailored intervention compared to sepsis
(although all are acute conditions). Patients in intensive care
with diagnosed ipSIRS are usually administered a number of
therapeutic compounds--many of which have opposing actions on the
immune system and many of which could be counterproductive
depending on the severity of ipSIRS (sepsis, severe sepsis, septic
shock). Monitoring intensive care patients on a regular basis with
biomarkers of the present invention will allow medical
practitioners to determine the severity of ipSIRS (mild, severe or
shock) and hence choice of therapies and patient management
procedures, and ultimately response to therapy. Information
provided by these biomarkers disclosed herein will therefore allow
medical practitioners to tailor, modify or cease therapies and/or
care to ensure patients survive and spend less time in intensive
care. Less time in intensive care leads to considerable savings in
medical expenses including through less occupancy time and
appropriate use and timing of medications.
First Example Workflow
[1135] A first example workflow will now be described. The workflow
involves up to seven steps depending upon availability of automated
platforms. The assay uses quantitative, real-time determination of
the amount of each transcript in the sample based on the detection
of fluorescence on a qRT-PCR instrument (e.g. Applied Biosystems
7500 Fast Dx Real-Time PCR Instrument, Applied Biosystems, Foster
City, Calif., catalogue number 440685; K082562). Transcripts are
each amplified, detected, and quantified in a separate reaction
well using a probe that is visualized in the FAM channel (by
example). The reported score is calculated using interpretive
software provided separately to the kit but designed to integrate
with RT-PCR machines.
[1136] The workflow below describes the use of manual processing
and a pre-prepared kit.
Pre-Analytical
[1137] Blood collection
[1138] Total RNA isolation
Analytical
[1139] Reverse transcription (generation of cDNA)
[1140] qPCR preparation
[1141] qPCR
[1142] Software, Interpretation of Results and Quality Control
[1143] Output.
Kit Contents
[1144] Diluent
[1145] RT Buffer
[1146] RT Enzyme Mix
[1147] qPCR Buffer
[1148] Primer/Probe Mix
[1149] AmpliTaq Gold.RTM. (or similar)
[1150] High Positive Control
[1151] Low Positive Control
[1152] Negative Control
Blood Collection
[1153] The specimen used is a 2.5 mL sample of blood collected by
venipuncture using the PAXgene.RTM. collection tubes within the
PAXgene.RTM. Blood RNA System (Qiagen, kit catalogue #762164;
Becton Dickinson, Collection Tubes catalogue number 762165;
K042613). An alternate collection tube is Tempus.RTM. (Life
Technologies).
Total RNA Isolation
[1154] Blood (2.5 mL) collected into a PAXgene RNA tube is
processed according to the manufacturer's instructions. Briefly,
2.5 mL sample of blood collected by venipuncture using the
PAXgene.TM. collection tubes within the PAXgene.TM. Blood RNA
System (Qiagen, kit catalogue #762164; Becton Dickinson, Collection
Tubes catalogue number 762165; K042613). Total RNA isolation is
performed using the procedures specified in the PAXgene.TM. Blood
RNA kit (a component of the PAXgene.TM. Blood RNA System). The
extracted RNA is then tested for purity and yield (for example by
running an A.sub.260/280 ratio using a Nanodrop.RTM. (Thermo
Scientific)) for which a minimum quality must be (ratio >1.6).
RNA should be adjusted in concentration to allow for a constant
input volume to the reverse transcription reaction (below). RNA
should be processed immediately or stored in single-use volumes at
or below -70.degree. C. for later processing.
Reverse Transcription
[1155] Determine the appropriate number of reaction equivalents to
be prepared (master mix formulation) based on a plate map and the
information provided directly below. Each clinical specimen is run
in singleton. [1156] a) Each batch run must include the following
specimens: [1157] b) High Control, Low Control, Negative Control,
and No Template Control (Test Diluent instead of sample) in
singleton each Program the ABI 7500 Fast Dx Instrument as detailed
below. [1158] c) Launch the software. [1159] d) Click Create New
Document [1160] e) In the New Document Wizard, select the following
options: [1161] i) Assay: Standard Curve (Absolute Quantitation)
[1162] ii) Container: 96-Well Clear [1163] iii) Template: Blank
Document (or select a laboratory-defined template) [1164] iv) Run
Mode: Standard 7500 [1165] v) Operator: Enter operator's initials
[1166] vi) Plate name: [default] [1167] f) Click Finish [1168] g)
Select the Instrument tab in the upper left [1169] h) In the
Thermal Cycler Protocol area, Thermal Profile tab, enter the
following times: [1170] i) 25.degree. C. for 10 minutes [1171] ii)
45.degree. C. for 45 minutes [1172] iii) 93.degree. C. for 10
minutes [1173] iv) Hold at 25.degree. C. for 60 minutes
[1174] In a template-free area, remove the test Diluent and RT-qPCR
Test RT Buffer to room temperature to thaw. Leave the RT-qPCR Test
RT Enzyme mix in the freezer and/or on a cold block.
[1175] In a template-free area, assemble the master mix in the
order listed below.
RT Master Mix--Calculation:
TABLE-US-00001 [1176] Per well .times.N RT-qPCR Test RT Buffer 3.5
.mu.L 3.5 .times. N RT-qPCR Test RT Enzyme mix 1.5 .mu.L 1.5
.times. N Total Volume .sup. 5 .mu.L .sup. 5 .times. N
[1177] Gently vortex the master mix then pulse spin. Add the
appropriate volume (5 .mu.L) of the RT Master Mix into each well at
room temperature.
[1178] Remove clinical specimens and control RNAs to thaw. (If the
specimens routinely take longer to thaw, this step may be moved
upstream in the validated method.)
[1179] Vortex the clinical specimens and control RNAs, then pulse
spin. Add 10 .mu.L of control RNA or RT-qPCR Test Diluent to each
respective control or negative well.
[1180] Add 10 .mu.L of sample RNA to each respective sample well
(150 ng total input for RT; OD.sub.260/OD.sub.280 ratio greater
than 1.6). Add 10 .mu.L of RT-qPCR Test Diluent to the respective
NTC well.
[1181] Note: The final reaction volume per well is 15 .mu.L.
TABLE-US-00002 Samples RT Master Mix 5 .mu.L RNA sample 10 .mu.L
Total Volume (per well) 15 .mu.L
[1182] Mix by gentle pipetting. Avoid forming bubbles in the
wells.
[1183] Cover wells with a seal.
[1184] Spin the plate to remove any bubbles (1 minute at
400.times.g).
[1185] Rapidly transfer to ABI 7500 Fast Dx Instrument
pre-programmed as detailed above.
[1186] Click Start. Click Save and Continue. Before leaving the
instrument, it is recommended to verify that the run started
successfully by displaying a time under Estimated Time
Remaining.
[1187] qPCR master mix may be prepared to coincide roughly with the
end of the RT reaction. For example, start about 15 minutes before
this time. See below.
[1188] When RT is complete (i.e. resting at 25.degree. C.; stop the
hold at any time before 60 minutes is complete), spin the plate to
collect condensation (1 minute at 400.times.g).
qPCR Preparation
[1189] Determine the appropriate number of reaction equivalents to
be prepared (master mix formulation) based on a plate map and the
information provided in RT Preparation above.
[1190] Program the ABI 7500 Fast Dx with the settings below. [1191]
a) Launch the software. [1192] b) Click Create New Document [1193]
c) In the New Document Wizard, select the following options: [1194]
i) Assay: Standard Curve (Absolute Quantitation) [1195] ii)
Container: 96-Well Clear [1196] iii) Template: Blank Document (or
select a laboratory-defined template) [1197] iv) Run Mode: Standard
7500 [1198] v) Operator: Enter operator's initials [1199] vi) Plate
name: Enter desired file name [1200] d) Click Next [1201] e) In the
Select Detectors dialog box: [1202] i) Select the detector for the
first biomarker, and then click Add>>. [1203] ii) Select the
detector second biomarker, and then click Add>>, etc. [1204]
iii) Passive Reference: ROX [1205] f) Click Next [1206] g) Assign
detectors to appropriate wells according to plate map. [1207] i)
Highlight wells in which the first biomarker assay will be assigned
[1208] ii) Click use for the first biomarker detector [1209] iii)
Repeat the previous two steps for the other biomarkers [1210] iv)
Click Finish [1211] h) Ensure that the Setup and Plate tabs are
selected [1212] i) Select the Instrument tab in the upper left
[1213] j) In the Thermal Cycler Protocol area, Thermal Profile tab,
perform the following actions, with the results shown in FIG. 14:
[1214] i) Delete Stage 1 (unless this was completed in a
laboratory-defined template). [1215] ii) Enter sample volume of 25
.mu.L. [1216] iii) 95.degree. C. 10 minutes [1217] iv) 40 cycles of
95.degree. C. for 15 seconds, 63.degree. C. for 1 minute [1218] v)
Run Mode: Standard 7500 [1219] vi) Collect data using the "stage 2,
step 2 (63.0@1:00)" setting [1220] k) Label the wells as below
using this process: Right click over the plate map, then select
Well Inspector. With the Well Inspector open, select a well or
wells. Click back into the Well Inspector and enter the Sample
Name. Close the Well Inspector when completed. [1221] i) CONH for
High Control [1222] ii) CONL for Low Control [1223] iii) CONN for
Negative Control [1224] iv) NTC for No Template Control [1225] v)
[Accession ID] for clinical specimens [1226] l) Ensure that
detectors and quenchers are selected as listed below. [1227] i) FAM
for CEACAM biomarker 1; quencher=none [1228] ii) FAM for LAMP1
biomarker 2; quencher=none, etc. [1229] iii) FAM for PLA2G7;
quencher=none [1230] iv) FAM for PLACE; quencher=none [1231] v)
Select "ROX" for passive reference qPCR
[1232] In a template-free area, remove the assay qPCR Buffer and
assay Primer/Probe Mixes for each target to room temperature to
thaw. Leave the assay AmpliTaq Gold in the freezer and/or on a cold
block.
[1233] Still in a template-free area, prepare qPCR Master Mixes for
each target in the listed order at room temperature.
qPCR Master Mixes--Calculation Per Sample
TABLE-US-00003 Per well .times.N qPCR Buffer 11 .mu.L 11 .times. N
Primer/Probe Mix 3.4 .mu.L 3.4 .times. N AmpliTaq Gold .RTM. 0.6
.mu.L 0.6 .times. N Total Volume 15 .mu.L 15 .times. N
[1234] Gently mix the master mixes by flicking or by vortexing, and
then pulse spin. Add 15 .mu.L of qPCR Master Mix to each well at
room temperature.
[1235] In a template area, add 130 .mu.L of SeptiCyte Lab Test
Diluent to each cDNA product from the RT Reaction. Reseal the plate
tightly and vortex the plate to mix thoroughly.
[1236] Add 10 .mu.L of diluted cDNA product to each well according
to the plate layout.
[1237] Mix by gentle pipetting. Avoid forming bubbles in the
wells.
[1238] Cover wells with an optical seal.
[1239] Spin the plate to remove any bubbles (1 minute at
400.times.g).
[1240] Place on real-time thermal cycler pre-programmed with the
settings above.
[1241] Click Start. Click Save and Continue. Before leaving the
instrument, it is recommended to verify that the run started
successfully by displaying a time under Estimated Time
Remaining.
[1242] Note: Do not open the qPCR plate at any point after
amplification has begun. When amplification has completed, discard
the unopened plate.
Software, Interpretation of Results and Quality Control
[1243] Software is specifically designed to integrate with the
output of PCR machines and to apply an algorithm based on the use
of multiple biomarkers. The software takes into account appropriate
controls and reports results in a desired format.
[1244] When the run has completed on the ABI 7500 Fast Dx
Instrument, complete the steps below in the application 7500 Fast
System with 21 CFR Part 11 Software, ABI software SDS v1.4.
[1245] Click on the Results tab in the upper left corner.
[1246] Click on the Amplification Plot tab in the upper left
corner.
[1247] In the Analysis Settings area, select an auto baseline and
manual threshold for all targets. Enter 0.01 as the threshold.
[1248] Click on the Analyze button on the right in the Analysis
Settings area.
[1249] From the menu bar in the upper left, select File then
Close.
[1250] Complete the form in the dialog box that requests a reason
for the change. Click OK.
[1251] Transfer the data file (.sds) to a separate computer running
the specific assay RT-qPCR Test Software.
[1252] Launch the assay RT-qPCR Test Software. Log in.
[1253] From the menu bar in the upper left, select File then
Open.
[1254] Browse to the location of the transferred data file (.sds).
Click OK.
[1255] The data file will then be analyzed using the assay's
software application for interpretation of results.
Interpretation of Results and Quality Control
Results
[1256] Launch the interpretation software. Software application
instructions are provided separately.
[1257] Following upload of the .sds file, the Software will
automatically generate classifier scores for controls and clinical
specimens.
[1258] Controls
[1259] The Software compares each CON (control) specimen (CONH,
CONL, CONN) to its expected result. The controls are run in
singleton.
TABLE-US-00004 Control specimen Designation Name Expected result
CONH High Control Score range CONL Low Control Score range CONN
Negative Control Score range NTC No Template Control Fail (no Ct
for all targets)
[1260] If CONH, CONL, and/or CONN fail the batch run is invalid and
no data will be reported for the clinical specimens. This
determination is made automatically by the interpretive software.
The batch run should be repeated starting with either a new RNA
preparation or starting at the RT reaction step.
[1261] If NTC yields a result other than Fail (no Ct for all
targets), the batch run is invalid and no data may be reported for
the clinical specimens. This determination is made by visual
inspection of the run data. The batch run should be repeated
starting with either a new RNA preparation or starting at the RT
reaction step.
[1262] If a second batch run fails, please contact technical
services. If both the calibrations and all controls are valid, then
the batch run is valid and specimen results will be reported.
[1263] Specimens
[1264] Note that a valid batch run may contain both valid and
invalid specimen results.
[1265] Analytical criteria (e.g. Ct values) that qualify each
specimen as passing or failing (using pre-determined data) are
called automatically by the software.
[1266] Scores out of range--reported.
[1267] Quality Control
[1268] Singletons each of the Negative Control, Low Positive
Control, and High Positive Control must be included in each batch
run. The batch is valid if no flags appear for any of these
controls.
[1269] A singleton of the No Template Control is included in each
batch run and Fail (no Ct for all targets) is a valid result
indicating no amplifiable material was detectable in the well.
[1270] The negative control must yield a Negative result. If the
negative control is flagged as Invalid, then the entire batch run
is invalid.
[1271] The low positive and high positive controls must fall within
the assigned ranges. If one or both of the positive controls are
flagged as Invalid, then the entire batch run is invalid.
Example Output
[1272] A possible example output from the software is presented
below in FIG. 15. The format of such a report depends on many
factors including; quality control, regulatory authorities, cut-off
values, the algorithm used, laboratory and clinician requirements,
likelihood of misinterpretation.
[1273] In this instance the assay is called "SeptiCyte Lab Test".
The result is reported as a number (5.8), a call ("Sepsis
Positive"), a position on a 0-12 scale, and a probability of the
patient having sepsis based on historical results and the use of a
pre-determined cut-off (using results from clinical trials).
Results of controls within the assay are also reported. Other
information that could be reported might include: previous results
and date and time of such results, probability of severe sepsis or
septic shock, a scale that provides cut-off values for historical
testing results that separate the conditions of healthy, inSIRS and
ipSIRS (mild, severe and shock) such that those patients with
higher scores are considered to have more severe inSIRS or
ipSIRS.
Second Example Workflow
[1274] A second example workflow will now be described. Machines
have been, and are being, developed that are capable of processing
a patient sample at point-of-care, or near point-of-care. Such
machines require few molecular biology skills to run and are aimed
at non-technical users. The idea is that the sample would be
pipetted directly into a disposable cartridge that is then inserted
into the machine. The user presses "Start" and within 2-3 hours a
result is generated. The cartridge contains all of the required
reagents to perform Steps 2-5 in the example workflow above and the
machine has appropriate software incorporated to allow Steps 6 and
7 to be performed.
[1275] Fresh, whole, anti-coagulated blood can be pipetted into an
Idylla Cartridge (Biocartis NV) or similar (Unyvero, Curetis AG;
Enigma ML, Enigma Diagnostics; DiagCore, STAT Diagnostica;
Savannah, Quidel Corp; ePlex, GenMark Dx), and on-screen
instructions on the Idylla machine followed to test for
differentiating inSIRS and ipSIRS (by example). Inside the Idylla
machine RNA is first extracted from the whole blood and is then
converted into cDNA. The cDNA is then used in qRT-PCR reactions.
The reactions are followed in real time and Ct values calculated.
On-board software generates a result output (see Figure XX).
Appropriate quality control measures for RNA quality, no template
controls, high and low template controls and expected Ct ranges
ensure that results are not reported erroneously.
Example Biomarker Ratios
[1276] Example biomarker ratios (the top 12 based on AUC) that are
capable of separating different conditions are shown in the box and
whisker plots as listed below, with each showing perfect
separation. [1277] FIGS. 16A to 16L show Healthy Versus inSIRS
(Post-Surgical) [1278] FIGS. 17A to 17L show Healthy Versus ipSIRS
(Sepsis) [1279] FIGS. 18A to 18L show inSIRS (Post-Surgical) Versus
ipSIRS (Sepsis) [1280] FIGS. 19A to 19L show Sepsis Versus Severe
Sepsis [1281] FIGS. 20A to 20L show Severe Sepsis Versus Septic
Shock [1282] FIGS. 21A to 21L show Sepsis Versus Septic Shock
Example Algorithm Combining Biomarker Ratios
[1283] Biomarker ratios (derived markers) can be used in
combination to increase the diagnostic power for separating various
conditions. Determining which markers to use, and how many, for
separating various conditions can be achieved by calculating Area
Under Curve (AUC).
[1284] FIG. 22 shows the effect on AUC (in this instance for
separating inSIRS and ipSIRS) of adding biomarkers to the
diagnostic signature. Diagnostic power significantly increases
(adjusted p-value=0.0175) between a single mRNA biomarker (in this
instance PLA2G7, AUC of 0.88, 95% CI 0.79-0.97) compared to the
power of the two best performing markers in combination (in this
instance PLA2G7 and PLAC8, AUC of 0.96, 95% CI 0.91-1.0).
Combinations of two, three, four and five biomarkers produced
equally as good differentiation of inSIRS and ipSIRS without
significant differences. For commercial development of derived
markers other factors come into play such as cost-effectiveness,
assay complexity and capabilities of the qRT-PCR platform.
[1285] In this example, the addition of markers beyond 3 or 4 does
not significantly improve performance and, conversely, a decline in
AUC is observed in signatures of .gtoreq.5 genes probably because
when a statistical model is forced to include biomarkers that add
little additional information data over-fitting and addition of
noise occurs.
[1286] As such, and by example, a 4-gene signature (0.986, 95% CI
0.964-1.00) offers the appropriate balance between simplicity,
practicality and commercial risk for separating inSIRS and ipSIRS.
Further, an equation using four markers weighs each biomarker
equally which also provides additional robustness in cases of
analytical or clinical variability.
[1287] One example equation that provides good diagnostic power for
separating inSIRS and ipSIRS (amongst others) is:
Diagnostic Score=(PLA2G7-PLAC8)+(CEACAM4-LAMP1)
[1288] The value for each biomarker is a Ct value from a PCR. When
clinical samples from patients with inSIRS and ipSIRS were tested
using these four markers in a PCR the Ct values for each of the
markers was found to fall between 26 and 34. In this patient
population the first biomarker within each bracket pair has a
higher value than the second biomarker within each bracket pair.
Thus, the "Diagnostic Score" has been found to have values between
0 and 12. However, in theory the "Diagnostic Score could
potentially be highest Ct value +/- highest Ct value.
[1289] In FIG. 23 shows results of PCR and the use of the above
algorithm have been calculated for two patient populations (N=63
for "Discovery" and N=70 for "Feasibility"). Each patient was
clinically and retrospectively (note, not at the time the sample
was taken) confirmed as having either inSIRS (black dots) or ipSIRS
(red dots). Each patient sample has also had a SeptiCyte score
calculated (Y axis on left hand side). On a scale of 0-12 it can be
seen that patients with confirmed ipSIRS (red dots) obtain a higher
Diagnostic Score compared to those with confirmed inSIRS. Further,
it can be seen that an arbitrary cut-off line can be drawn that
more or less separates the two conditions depending upon the
desired false negative or false positive rate (compared to a
retrospective diagnosis of inSIRS or ipSIRS using clinical data).
In this instance the line is drawn at a "SeptiCyte Score" of 4 such
that the number of false negative ipSIRS calls in the Discovery
Dataset is zero and the number of false negative ipSIRS calls in
the Feasibility Dataset is 2. Conversely the number of false
positive ipSIRS calls in the Discovery Dataset is four and the
number of false positive ipSIRS calls in the Feasibility Dataset is
9. Clearly in this instance whether a patient sample is false
positive or false negative depends on the artificial gold standard
of a retrospective clinical call of inSIRS or ipSIRS.
[1290] Accordingly, in one example, when used for determining a
likelihood of the subject having inSIRS or ipSIRS, the method can
include determining a first pair of biomarker values indicative of
a concentration of polynucleotide expression products of the PLA2G7
gene and PLAC8 gene, determining a second pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the CEACAM4 gene and LAMP1 gene and then determining an
indicator using the first and second pairs of biomarker values.
[1291] As previously discussed, the indicator could then be
compared to indicator references specifically established to
distinguish between inSIRS and ipSIRS.
[1292] An example process of a process for establishing indicator
references will now be described in more details with reference to
FIG. 24.
[1293] In this example, at step 2400 the processing system 201
determines reference data in the form of measured biomarker values
obtained for a reference population. The reference data may be
acquired in any appropriate manner but typically this involves
obtaining gene expression product data from a plurality of
individuals.
[1294] In order to achieve this, gene expression product data are
collected, for example by obtaining a biological sample, such as a
peripheral blood sample, and then performing a quantification
process, such as a nucleic acid amplification process, including
PCR (Polymerase Chain Reaction) or the like, in order to assess the
activity, and in particular, level or abundance of a number of
reference biomarkers. Quantified values indicative of the relative
activity are then stored as part of the reference data.
[1295] In one example, the measurements are received as raw data,
which then undergoes preliminary processing. Such raw data
corresponds to information that has come from a source without
modification, such as outputs from instruments such as PCR
machines, array (e.g., microarray) scanners, sequencing machines,
clinical notes or any other biochemical, biological, observational
data, or the like. This step can be used to convert the raw data
into a format that is better suited to analysis. In one example
this is performed in order to normalize the raw data and thereby
assist in ensuring the biomarker values demonstrate consistency
even when measured using different techniques, different equipment,
or the like. Thus, the goal of normalization is to remove the
variation within the samples that is not directly attributable to
the specific analysis under consideration. For example, to remove
variances caused by differences in sample processing at different
sites. Classic examples of normalization include z-score
transformation for generic data, or popular domain specific
normalizations, such as RMA normalization for microarrays.
[1296] However, it will also be appreciated that in some
applications, such as a single sample experiment run on a single
data acquisition machine, this step may not strictly be necessary,
in which case the function can be a Null function producing an
output identical to the input.
[1297] In one example, the preferred approach is a paired function
approach over log normalized data. Log normalization is a standard
data transformation on microarray data, because the data follow a
log-normal distribution when coming off the machine. Applying a log
transform turns the data into process-friendly normal data.
[1298] The individuals are selected to include individuals
diagnosed with one or more conditions of interest, as well as
healthy individuals The conditions are typically medical,
veterinary or other health status conditions and may include any
illness, disease, stages of disease, disease subtypes, severities
of disease, diseases of varying prognoses or the like, and in the
current example would include at least some individuals with inSIRS
and some individuals with ipSIRS. In this regard, the individuals
also typically undergo a clinical assessment allowing the
conditions to be clinically identified, and with an indication of
any assessment or condition forming part of the reference data.
[1299] The biomarker values measured will depend on the predominant
condition that is being assessed so, for example, in the case of
determining the likelihood of a subject having inSIRS or ipSIRS,
the biomarkers used will be LAMP1, CEACAM4, PLAC8 and PLA2G7, as
discussed above.
[1300] Once collected, the reference data can be stored in the
database 211 allowing this to be subsequently retrieved by the
processing system 201 for subsequent analysis, or could be provided
directly to the processing system 201 for analysis.
[1301] As part of the above process, at step 2410 the measurements
are validated using traditional prior art techniques, to ensure
that the measurements have been performed successfully, and hence
are valid.
[1302] At step 2420, each individual with the reference population
is typically allocated to a group. The groups may be defined in any
appropriate manner and may be defined based on any one or more of
an indication of a presence, absence, degree, stage, severity,
prognosis or progression of a condition, other tests or assays, or
measured biomarkers associated with the individuals.
[1303] For example, a first selection of groups may be to identify
one or more groups of individuals suffering from SIRS, one or more
groups of individuals suffering ipSIRS, and one or more groups of
individuals suffering inSIRS. Further groups may also be defined
for individuals suffering from other conditions. The groups may
include overlapping groups, so for example it may be desirable to
define groups of healthy individuals and individuals having SIRS,
with further being defined to distinguish inSIRS patients from
ipSIRS patients, as well as different degree of inSIRS or ipSIRS,
with these groups having SIRS in common, but each group of patients
differing in whether a clinician has determined the presence of an
infection or not. Additionally, further subdivision may be
performed based on characteristics of the individuals, phenotypic
traits, measurement protocols or the like, so groups could be
defined based on these parameters so that a plurality of groups of
individuals suffering from a condition are defined, with each group
relating to a different phenotypic trait, measurement protocol or
the like.
[1304] It will also be appreciated, however, that identification of
different groups can be performed in other manners, for example on
the basis of particular activities of biomarkers within the
biological samples of the reference individuals, and accordingly,
reference to conditions is not intended to be limiting and other
information may be used as required.
[1305] The manner in which classification into groups is performed
may vary depending on the preferred implementation. In one example,
this can be performed automatically by the processing system 201,
for example, using unsupervised methods such as Principal
Components Analysis (PCA), or supervised methods such as k-means or
Self Organizing Map (SOM). Alternatively, this may be performed
manually by an operator by allowing the operator to review
reference data presented on a Graphical User Interface (GUI), and
define respective groups using appropriate input commands.
[1306] At step 2430, first and second derived biomarker values are
determined representing respective indicator values. The first and
second indicator values In.sub.1, In.sub.2 are determined on a
basis of ratios of concentrations of first and second, and third
and fourth biomarkers respectively: [1307] In.sub.1=(PLA2G7/PLACE)
[1308] In.sub.2=(CEACAM4/LAMP1)
[1309] The indicator values are then used to establish indicator
references at step 2440, which are then used in analyzing measured
indicator values for a subject to establish a likelihood of the
subject having a condition.
[1310] In particular, indicator values for each reference group are
statistically analyzed to establish a range or distribution of
indicator values that is indicative of each group, and an example
distribution is shown in FIG. 26, as will be discussed in more
detail below.
[1311] A further example will now be described with reference to
FIGS. 25A and 25B.
[1312] In this example, at step 2500 a sample is acquired from the
subject. The sample could be any suitable sample such as a
peripheral blood sample, or the like, depending on the nature of
the biomarker values being determined At step 2505 the sample
undergoes preparation allowing this to be provided to a measuring
device and used in a quantification process at step 2510. For this
purpose of this example, the quantification process involves PCR
amplification, with the measuring device being a PCR machine,
although other suitable techniques could be used. In this instance,
amplifications times At(PLA2G7), At(PLAC8), At(CEACAM4), At(LAMP1)
are determined for each of the four biomarkers at step 2515, with
the amplification times being transferred from the measuring device
to the processing system 201 allowing the processing system 201 to
perform analysis of the corresponding biomarker values.
[1313] Accordingly, at step 2520 the processing system 201
calculates ratios using the amplifications times. In this regard,
as the amplification times represent a log value, the ratios are
determined by subtracting amplifications times as will be
appreciated by a person skilled in the art.
[1314] Accordingly, in this example the indicator values would be
determined as follows: [1315] In.sub.1=At(PLA2G7)-At(PLAC8) [1316]
In.sub.2=At(CEACAM4)-At(LAMP1)
[1317] At step 2525 the processing system 201 determines an
indicator value by combining the ratios for the indicator values,
as follows: [1318] In=In.sub.1+In.sub.2
[1319] The processing system 201 then compares the indicator value
to one or more respective indicator references at step 2530.
[1320] As previously described, the indicator references are
derived for a reference population and are used to indicate the
likelihood of a subject suffering from inSIRS or ipSIRS. To achieve
this, the reference population is grouped based on a clinical
assessment into groups having/not having the conditions or a
measure of severity, risk or progression stage of the condition,
with this then being used to assess threshold indicator values that
can distinguish between the groups or provide a measure of
severity, risk or progression stage.
[1321] The comparison is performed by comparing the indicator to an
indicator distribution determined for each group in the reference
population. In the current example, there are two reference groups,
with one corresponding to individuals diagnosed with inSIRS and the
other for individuals diagnosed with ipSIRS. In this instance, the
results of the comparison can be used to determine a likelihood of
the individual having ipSIRS as opposed to inSIRS. This can be
achieved using a number of different methods, depending on the
preferred implementation.
[1322] An example of a reference distribution is shown in FIG. 26,
which shows the distribution of indicator values for a reference
population containing both inSIRS and ipSIRS samples. The density
(y axis) describes how common scores are in the reference
population. In FIG. 26, the most common values for the inSIRS
population are in the range 1 to 8, and for the ipSIRS population
are mostly in the range 5 to 13. By way of example, let us assume
that the calculated indicator value for a new sample is 4. A value
of 4 in the inSIRS population has a high density at this value (A),
while the ipSIRS population has a low density at this value (B),
meaning that this sample is more likely to be inSIRS. Conversely,
if a sample has an indicator score of 10, this value in the ipSIRS
reference population has a high density (C), while the inSIRS
population has a low density (D), meaning this it is more probable
that this sample with an indicator value of 10 belongs to the
ipSIRS population.
[1323] In practice this process can be performed by determining a
basic probability based on score bands. For a given score band
(i.e. 4-6), the proportion of individuals with SIRS or SEPSIS is
calculated. For example, if 40% of the scores between 4 and 6 were
SEPSIS, then if an subject has an indicator value between 4 and 6,
they have a 40% probability of sepsis. Thus, for a given range
within the reference distribution, the probability of belonging to
one group or another (SIRS/SEPSIS) can simply be the proportion of
that group within the range.
[1324] An alternative technique is a standard Bayes method. In this
case, the technique uses a distribution of inSIRS scores, a
distribution of ipSIRS scores and an indicator value for the
subject. In this example, a standard score or equivalent is used to
generate a probability of the indicator value belonging to the
inSIRS distribution: pr(inSIRS) and separately to the ipSIRS
distribution: pr(ipSIRS). The Bayes method is used to generate the
probability of ipSIRS given the individual distributions.
[1325] Thus, given derived biomarker distributions for two or more
groups (i.e. inSIRS/ipSIRS), the probability of membership for a
single unknown sample into each distribution can be calculated
(p-value) using for example a standard score (z-score). Then the
p-values for each distribution can be combined into an overall
probability for each class (i.e. inSIRS/ipSIRS) using for example
Bayes rule or any other probability calculation method (including
frequentist or empirical or machine learned methods).
[1326] Thus, once the indicator value has been derived and compared
to the indicator distributions, the results of this comparison are
used by the processing system 201 to calculate a likelihood of the
subject having ipSIRS at step 2535, with this being used to
generate a representation of the results at step 2540, which is
provided for display at step 2545, for example to a clinician or
medical practitioner. This can be achieved by displaying the
representation on a client device, such as part of an email,
dashboard indication or the like.
[1327] An example of the representation is shown in FIGS. 27A and
27B.
[1328] In this example, the representation 2700 includes a pointer
2710 that moves relative to a linear scale 2720. The linear scale
is divided into regions 2721, 2722, 2723, 2724 which indicate
whether the subject is suffering from level 1, 2, 3 or 4.
Corresponding indicator number values are displayed at step 2730
with an indication of whether the corresponding value represents a
likelihood of SIRS (inSIRS) or SEPSIS (ipSIRS) being shown at step
2740. An alphanumeric indication of the score is shown at step 2751
together with an associated probability of the biological subject
having SEPSIS at step 2752.
[1329] As shown in this example, regions of the linear scale where
the pointer is situated are highlighted with the diagnosis that is
most unlikely being greyed out to make it absolutely clear where
the subject sits on the scale. This results in a representation
which when displayed at step 2545 is easy for a clinician to
readily understand and to make a rapid diagnosis.
[1330] It will be appreciated from the above that a method can be
provided for use in assessing the likelihood of a biological
subject having inSIRS or ipSIRS the method including, in one or
more processing devices: [1331] a) determining a pair of biomarker
values, the pair of biomarker values being selected from the group
consisting of: [1332] i) a first pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the PLA2G7 gene and PLAC8 gene; [1333] ii) a second pair of
biomarker values indicative of a concentration of polynucleotide
expression products of the CEACAM4 gene and LAMP1 gene; [1334] b)
determining an indicator indicative of a ratio of the
concentrations of the polynucleotide expression products using the
pair of biomarker values; [1335] c) retrieving previously
determined first and second indicator references from a database,
the first and second indicator references being determined based on
indicators determined from first and second groups of a reference
population, one of the groups consisting of individuals diagnosed
with the medical condition; [1336] d) comparing the indicator to
the first and second indicator references; [1337] e) using the
results of the comparison to determine a probability indicative of
the subject having the medical condition; and, [1338] f) generating
a representation of the probability, the representation being
displayed to a user to allow the user to assess the likelihood of a
biological subject having at least one medical condition.
[1339] Similarly apparatus can be provided for determining the
likelihood of a biological subject having inSIRS or ipSIRS, the
apparatus including: [1340] a) a sampling device that obtains a
sample taken from a biological subject, the sample including
polynucleotide expression products; [1341] b) a measuring device
that quantifies polynucleotide expression products within the
sample to determine a pair of biomarker values, the pair of
biomarker values being selected from the group consisting of:
[1342] i) a first pair of biomarker values indicative of a
concentration of polynucleotide expression products of the PLA2G7
gene and PLAC8 gene; [1343] ii) a second pair of biomarker values
indicative of a concentration of polynucleotide expression products
of the CEACAM4 gene and LAMP1 gene; [1344] c) at least one
processing device that: [1345] i) receives an indication of the
pair of biomarker values from the measuring device; [1346] ii)
determines an indicator using a ratio of the concentration of the
first and second polynucleotide expression products using the
biomarker values; and, [1347] iii) compares the indicator to at
least one indicator reference; and, [1348] iv) determines a
likelihood of the subject having the at least one medical condition
using the results of the comparison; and, [1349] v) generates a
representation of the indicator and the likelihood for display to a
user.
[1350] A further method that can be provided includes
differentiating between inSIRS and ipSIRS in a biological subject,
the method including: [1351] a) obtaining a sample taken from a
biological subject showing a clinical sign of SIRS, the sample
including polynucleotide expression products; [1352] b) in a
measuring device: [1353] i) amplifying at least some polynucleotide
expression products in the sample; [1354] ii) determining an
amplification amount representing a degree of amplification
required to obtain a defined level of polynucleotide expression
products including: [1355] (1) amplification amounts for a first
pair of polynucleotide expression products of the PLA2G7 gene and
PLAC8 gene; [1356] (2) amplification amounts for a second pair of
polynucleotide expression products of the CEACAM4 gene and LAMP1
gene; [1357] c) in a processing system: [1358] i) retrieving the
amplification amounts; [1359] ii) determining an indicator by:
[1360] (1) determining a first derived biomarker value indicative
of a ratio of concentrations of the first pair of polynucleotide
expression products by determining a difference between the
amplification amounts for the first pair; [1361] (2) determining a
second derived biomarker value indicative of a ratio of
concentrations of the second pair of polynucleotide expression
products by determining a difference between the amplification
amounts for the second pair; [1362] (3) determining the indicator
by adding the first and second derived biomarker values; [1363]
iii) retrieving previously determined first and second indicator
references from a database, wherein the first and second indicator
references are distributions of indicators determined for first and
second groups of a reference population, the first and second group
consisting of individuals diagnosed with inSIRS and ipSIRS
respectively; [1364] iv) comparing the indicator to the first and
second indicator references; [1365] v) using the results of the
comparison to determine a probability of the subject being
classified within the first or second group; [1366] vi) generating
a representation at least partially indicative of the indicator and
the probability; and, [1367] vii) providing the representation to a
user to allow the user to assess the likelihood of a biological
subject having at least one medical condition.
[1368] Additionally, a method can be provided for determining an
indicator used in assessing a likelihood of a biological subject
having a presence, absence, degree or prognosis of at least one
medical condition, the method including: [1369] a) determining a
plurality of biomarker values, each biomarker value being
indicative of a value measured or derived for at least one
corresponding immune system biomarker of the biological subject and
being at least partially indicative of a concentration of the
immune system biomarker in a sample taken from the subject; [1370]
b) determining the indicator using a combination of the plurality
of biomarker values, wherein: [1371] i) at least two biomarkers
have a mutual correlation in respect of the at least one condition
that lies within a mutual correlation range, the mutual correlation
range being between .+-.0.9; and, [1372] ii) the indicator has a
performance value greater than or equal to a performance threshold
representing the ability of the indicator to diagnose the presence,
absence, degree or prognosis of the at least one condition, the
performance threshold being indicative of an explained variance of
at least 0.3.
[1373] Throughout this specification and claims which follow,
unless the context requires otherwise, the word "comprise", and
variations such as "comprises" or "comprising", will be understood
to imply the inclusion of a stated integer or group of integers or
steps but not the exclusion of any other integer or group of
integers.
[1374] Persons skilled in the art will appreciate that numerous
variations and modifications will become apparent. All such
variations and modifications which become apparent to persons
skilled in the art, should be considered to fall within the spirit
and scope that the invention broadly appearing before
described.
TABLE-US-00005 TABLE 1 SEQ HGNC .sup..sctn. Gene Name ID NO PRKCZ 1
SKI 2 RER1 3 TAS1R1 4 VAMP3 5 AGTRAP 6 VPS13D 7 KLHDC7A 8
NBL1//C1orf151 9 MDS2 10 RCAN3 11 LDLRAP1 12 MAN1C1 13 SH3BGRL3 14
DHDDS 15 HCRTR1 16 CCDC28B 17 LCK 18 ZNF362 19 THRAP3 20
PPIE//CCDC25 21 CAP1 22 CTPS 23 C1orf84 24 FAAH 25 DMBX1 26 CYP4B1
27 BTF3L4 28 LRRC42 29 C1orf175//TTC4 30 TMEM61 31 FPGT//TNNI3K 32
ACADM 33 SPATA1 34 EPHX4 35 RPAP2 36 RPL5//SNORA66// 37
SNORD21//FAM69A RTCD1 38 SLC30A7 39 RNPC3//AMY2B 40 CELSR2 41
AHCYL1 42 CEPT1//DRAM2 43 CHIA 44 LIX1L 45 UPF0627 46 MRPS21 47
TNFAIP8L2 48 SMCP 49 DCST1 50 RAG1AP1 51 C1orf182 52 HAPLN2 53
NTRK1 54 CD1E 55 TOMM40L//NR1I3 56 POU2F1 57 TIPRL 58 SFT2D2 59
CACNA1E 60 SMG7 61 OCLM 62 RGS2 63 ZC3H11A//RP11-74E24.2 64 MFSD4
65 IL20 66 RPS6KC1 67 C1orf95 68 ARF1 69 GALNT2 70 TNFRSF4 71 NADK
72 FLJ14100//C1orf86 73 GPR153 74 RERE 75 SLC2A7 76 SDHB 77 RNF186
78 DDOST 79 GPN2 80 RPA2 81 PEF1 82 PTP4A2 83 TRIM62 84 PHC2 85
LSM10 86 MRPS15 87 RRAGC 88 COL9A2 89 TESK2 90 NRD1 91 KTI12 92
CC2D1B 93 YIPF1 94 JAK1 95 SLC35D1 96 DIRAS3 97 ZZZ3 98 GNG5 99
ZNHIT6 100 ODF2L 101 SEP15 102 BARHL2 103 GCLM 104 CLCC1//GPSM2//
105 C1orf62 SORT1 106 SLC16A4 107 PHTF1 108 RSBN1 109
DENND2C//BCAS2 110 CD58 111 SPAG17//WDR3 112 REG4//NBPF7 113
RP11-94I2.2//NBPF16// 114 NBPF11//NBPF15// NBPF8//NBPF20//
NBPF10//NBPF14// NBPF1//LOC100288142// NBPF12//KIAA1245//
LOC100290137 APH1A 115 POGZ 116 TDRKH 117 THEM4 118 S100A11 119
CRNN 120 SPRR2C 121 S100A12 122 S100A8 123 GATAD2B//PLIN2 124
DENND4B 125 PBXIP1 126 PYGO2 127 SHC1 128 DCST2 129 GBA//GBAP 130
ASH1L 131 RIT1 132 MEF2D 133 AIM2 134 COPA 135 DEDD 136 TADA1L 137
GPA33 138 CD247 139 F5 140 PIGC 141 KIAA0040 142
TOR1AIP2//TOR1AIP1// 143 IFRG15 STX6//KIAA1614 144 EDEM3 145 UCHL5
146 DENND1B 147 DDX59 148 KIF21B 149 ARL8A 150 CYB5R1 151 MYBPH 152
CHI3L1 153 PIK3C2B//LOC100130573 154 NUAK2 155 NUCKS1 156 FAIM3 157
PLXNA2 158 SLC30A1 159 LPGAT1 160 ANGEL2 161 RAB3GAP2//AURKAPS1//
162 AURKA//SNORA36B TP53BP2 163 NVL 164 TMEM63A 165 PARP1 166 ITPKB
167 TARBP1 168 CHML 169 AKT3 170 SMYD3 171 AHCTF1 172 OR1C1 173
NCOA1 174 HADHB 175 ABHD1//PREB 176 SPAST 177 SLC30A6//DDX50 178
CRIPT 179 MSH2 180 FOXN2 181 CCDC104 182 VRK2 183 AHSA2//USP34 184
OTX1 185 AFTPH 186 CEP68 187 PLEK 188 ANXA4 189 MXD1 190 NAGK 191
SMYD5//NOTO 192 MTHFD2 193 TTC31 194 SEMA4F 195 TMSB10 196 SH2D6
197 GNLY 198 KCNIP3 199 CNNM4 200 CNNM3 201 ZAP70 202 LIPT1//MRPL30
203 MAP4K4 204 IL1R2 205 IL1R1 206 IL18R1 207 POLR1B 208 CHCHD5 209
IL1RN 210 PSD4 211 DDX18 212 INSIG2 213 TMEM177//LOC100125918 214
RALB 215 PROC 216 GPR17//LOC100291428// 217 LIMS2 IMP4 218 FAM123C
219 ACVR2A 220 MBD5 221 LYPD6B 222 SLC4A10 223 UBR3 224 HAT1 225
ITGA6 226 ZAK 227 OSBPL6 228 PLEKHA3 229 ZC3H15 230 COL3A1 231 GLS
232 OBFC2A 233
COQ10B 234 MARS2 235 CFLAR 236 NOP58 237 FAM117B 238 CYP20A1 239
FASTKD2 240 PIKFYVE 241 C2orf62 242 SLC11A1 243 AGFG1 244 CHRNG 245
EIF4E2 246 TRPM8 247 LRRFIP1 248 GAL3ST2 249 TMEM18 250 LAPTM4A 251
SF3B14 252 TP53I3 253 UNQ2999 254 GPR113//SELI 255 MPV17 256 PPM1G
257 NLRC4 258 CDC42EP3 259 HNRPLL 260 COX7A2L 261 KCNG3 262
CALM2//C2orf61 263 BCL11A 264 XPO1 265 NAT8B 266 DUSP11 267 MOGS
268 SNRNP200 269 SEMA4C 270 MITD1 271 IL1A 272 SLC35F5 273 CCDC93
274 CLASP1 275 SAP130 276 YSK4 277 GTDC1 278 ORC4L 279
NR4A2//FLJ46875 280 DPP4 281 GALNT3 282 SCN7A 283 FRZB 284 STK17B
285 CLK1//PPIL3 286 MPP4 287 INO80D 288 KLF7 289 FAM119A 290 NGEF
291 ARL4C 292 RAB17 293 HDLBP 294 LRRN1 295 SETD5 296 IRAK2 297
C3orf42 298 TSEN2 299 NR2C2//MRPS25 300 UBE2E1 301 C3orf35 302 SNRK
303 ZNF197 304 GNAI2 305 ALAS1 306 PRKCD 307 CACNA1D 308 PXK 309
PTPRG 310 ATXN7 311 SLC35A5 312 SLC15A2 313 CCDC48 314 DNAJC13 315
CLDN18 316 GYG1 317 SELT 318 MED12L 319 RAP2B 320 MYNN 321 ABCF3
322 VPS8 323 HRG 324 EIF4A2//SNORA4 325 LPP 326 CCDC50 327
LOC152217 328 TADA3L 329 SEC13 330 TIMP4 331 METTL6 332
DAZL//DAZ4//DAZ3//DAZ2 333 SATB1//TBC1D5 334 SCN10A 335 SEC22C 336
ZDHHC3a 337 ZDHHC3b 338 SLC6A20 339 UQCRC1 340 PRKAR2A 341 IMPDH2
342 CCDC71 343 UBA7 344 CAMKV 345 WDR82 346 LMOD3 347 FOXP1 348
MORC1 349 ATG3 350 GSK3B//LOC100129275 351 HCLS1 352 KPNA1 353
PTPLB 354 C3orf22 355 RPN1 356 KIAA1257//ACAD9// 357 LOC100132731
FOXL2 358 MECOM 359 PLD1 360 GNB4 361 MRPL47 362 KLHL6 363 THPO 364
ETV5 365 BCL6//LOC100131635 366 ATP13A5 367 TMEM44 368 KIAA1530 369
TACC3 370 CNO 371 BST1 372 KLF3 373 TMEM33//DCAF4L1 374 KIT 375
ENAM 376 FAM47E//STBD1 377 ENOPH1 378 PDLIM5 379 CCDC109B//HIGD1A//
380 CCDC13 EGF 381 PCDH10 382 RAB33B 383 TMEM184C 384 RBM46 385
GRIA2 386 C4orf39 387 KLHL2 388 TLL1 389 F11 390 SLBP 391
HAUS3//POLN 392 PPARGC1A 393 TLR10 394 C4orf34 395 TXK 396 RPL21P44
397 KDR 398 RCHY1 399 CNOT6L 400 PLAC8 401 HPSE 402 GPRIN3 403 PPA2
404 COL25A1 405 C4orf3 406 QRFPR 407 MFSD8 408 MAP9 409 PDGFC 410
TKTL2 411 ACSL1 412 SUB1//TMEM183A 413 CARD6 414 MCCC2 415 TNPO1
416 PDE8B 417 PAPD4 418 THBS4 419 FAM151B 420 RASGRF2 421 SNX2 422
LMNB1//PCIF1 423 MEGF10 424 LEAP2 425 TCF7 426 KDM3B 427 CXXC5 428
SLC4A9 429 ANKHD1-EIF4EBP3// 430 ANKHD1//EIF4EBP3 KIAA0141 431
GRPEL2 432 MFAP3 433 GABRA6 434 GABRA1 435 DOCK2 436 RANBP17//USP12
437 ERGIC1 438 ATP6V0E1//SNORA74B 439 ZNF346 440 NSD1 441 CLPTM1L
442 UGT3A1 443 GDNF 444 TTC33 445 hCG_2039148 446 MOCS2 447 SLC38A9
448 CCDC125 449 ANKRA2 450 HAPLN1 451 CCNH 452 TMEM161B 453 MBLAC2
454 MCTP1 455 TICAM2//TMED7// 456 TMED7-TICAM2 KIF3A 457 C5orf15
458 SKP1 459 CXCL14 460 KLHL3 461 CD14 462 YIPF5 463 LARS 464 DCTN4
465 CCDC69 466 ATOX1 467 TIMD4 468 ADAM19 469 SLIT3 470 RNF44 471
DOK3 472 MGAT4B//SQSTM1 473 C5orf45//SQSTM1 474 RASGEF1C 475 MGAT1
476 IRF4 477 HIVEP1 478 E2F3 479 HIST1H4I 480
HIST1H2BM 481 MOG 482 ZNRD1//NCRNA00171 483 TRIM15 484 HCG27 485
BAT2//SNORA38 486 CYP21A2 487 ITPR3 488 MAPK14 489 MAPK13 490
PNPLA1 491 SFRS3 492 CDKN1A 493 FOXP4 494 CUL9 495 RUNX2 496 ZNF451
497 SOBP 498 C6orf182 499 KIAA1919 500 RWDD1 501 KPNA5 502 TPD52L1
503 ARG1 504 RAB32 505 ARID1B 506 SLC22A3 507 SERPINB1 508 C6orf146
509 GCM2 510 ATXN1 511 DCDC2//KAAG1 512 HIST1H3I 513 HIST1H4L 514
GABBR1 515 RNA243 516 DDAH2 517 CLIC1 518 NEU1 519 RXRB 520 VPS52
521 TCP11 522 CLPS 523 PGC 524 ZNF318 525 YIPF3 526 MRPL14 527
PLA2G7 528 PKHD1 529 IL17F 530 HTR1B 531 GABRR2 532 UBE2J1 533
BACH2 534 MCM9 535 VNN1 536 IL20RA 537 FLJ27255 538 T 539 RPS6KA2
540 HGC6.3 541 UNC84A//C7orf20 542 SDK1 543 ZDHHC4 544 C7orf26 545
GLCCI1//tcag7.903 546 GPNMB 547 CCDC126 548 WIPF3//ZNRF2// 549
LOC441208 GPR141 550 STARD3NL 551 POU6F2 552 CDC2L5 553 ZMIZ2 554
UPP1 555 ZNF273 556 KCTD7//RABGEF1 557 RABGEF1//tcag7.967// 558
tcag7.951//KCTD7// LOC100293333 CCDC132 559 PVRIG//PILRB//STAG3 560
PILRB//PVRIG//STAG3 561 C7orf51 562 GNB2 563 LRRC17 564 LRRN3 565
CFTR 566 LSM8 567 LUC7L2 568 MGAM//LOC100124692 569 GIMAP7 570
INSIG1 571 RBM33 572 ICA1 573 FAM126A 574 HIBADH 575 TRIL 576 SCRN1
577 ELMO1 578 INHBA 579 CAMK2B 580 NPC1L1 581 DDC//LOC100129427 582
NSUN5//NSUN5B// 583 NSUN5C CLDN3 584 C7orf23//DMTF1 585 SRI 586
BET1 587 MCM7 588 GATS 589 ATXN7L1//RINT1// 590 EFCAB10 KIAA1549
591 SLC37A3 592 SMARCD3 593 MLL3//BAGE2 594 CLN8 595 MSRA 596
PIWIL2 597 NEFM//LOC100129717 598 EPHX2 599 LEPROTL1 600
MAK16//C8orf41 601 AP3M2 602 FNTA 603 SGK196 604 UBE2V2 605
FLJ46365 606 SNTG1 607 TRIM55 608 C8orf45 609 PREX2 610 PLEKHF2 611
BAALC//FLJ10489 612 TTC35 613 MTBP 614 ZHX2 615 RNF139 616 TG 617
DENND3//C8orf60 618 TNFRSF10D 619 TRIM35 620 GSR 621 WHSC1L1 622
PCMTD1//PXDNL 623 NCOA2 624 TRAM1//LOC286190 625 RUNX1T1 626 EXT1
627 DDEF1IT1 628 CDC37L1 629 UBE2R2 630 UBAP1//KIF24 631 GALT 632
RGP1//GBA2 633 TGFBR1 634 C9orf6//IKBKAP 635 IMAGE5303689 636
ATP6V1G1 637 TLR4 638 SET 639 MRPL41 640 C9orf68 641 HAUS6//SCARNA8
642 KLHL9 643 C9orf82 644 NDUFB6//DFFB 645 SIT1 646 FAM108B1 647
TRPM6 648 FRMD3 649 SLC28A3 650 BICD2 651 C9orf84 652 AKNA 653
MEGF9 654 C5 655 GOLGA1//SCAI 656 SH2D3C 657 FAM102A 658 FLJ10232
659 ASB6 660 BAT2L 661 EDF1 662 FBXW5 663 C10orf18 664 FBXO18 665
GATA3 666 CUGBP2 667 VIM 668 STAM 669 WAC 670 BAMBI 671
ZNF487//LOC439911 672 ALOX5 673 WDFY4 674 SRGN 675 CCDC109A 676
FAM149B1//FAM149B2 677 MINPP1 678 PTEN//PTENP1 679
ENTPD1//C10orf131 680 ABCC2 681 SFXN2 682 SHOC2 683 ACSL5 684
BCCIP//DHX32 685 FAM188A 686 CUBN 687 SVIL//hCG_1783494 688
FAM13C//PHYHIPL 689 ATAD1 690 ANKRD22 691 FLJ34077 692 COX15 693
ERLIN1 694 ACTR1A 695 ABLIM1 696 RAB11FIP2 697 C10orf84 698 PRDX3
699 C10orf110 700 NSMCE4A 701 TALDO1//INTS8 702 TNNT3 703 FXC1 704
PDE3B 705 DNAJC24 706 PTPRJ//OR4B1 707 C11orf31 708 TMEM109 709 CD6
710 CD5 711 TMEM138 712 POLR2G 713 TMEM179B 714 NAT11 715 OTUB1 716
RBM14//RBM4 717 AIP 718 PPFIA1 719 IL18BP//NUMA1 720 C11orf30 721
C11orf82 722 TMEM126B 723 C11orf73 724 PIWIL4 725 LOC100132686
726
PAFAH1B2 727 UBE4A 728 TRAPPC4 729 SC5DL 730 VWA5A//OR10D1P 731
STT3A 732 VPS26B 733 TRIM21 734 ZBED5 735 SAAL1 736 FANCF 737 LIN7C
738 PHF21A 739 CUGBP1 740 OSBP 741 CYBASC3 742 TUT1 743 SLC25A45
744 LTBP3 745 EIF1AD 746 GAB2 747 CREBZF 748 PICALM 749 SLC36A4 750
CCDC82 751 KIAA1826 752 MPZL3 753 MPZL2 754 H2AFX 755 SIAE 756
ZBTB44 757 HSN2 758 ADIPOR2 759 NCAPD2//SCARNA10// 760 FADS1 PTPN6
761 CLEC4D 762 CDKN1B 763 GOLT1B 764 FAR2 765 FGD4 766 TMEM106C 767
TMBIM6 768 C12orf62 769 PRR13//PCBP2 770 DGKA 771 COQ10A 772
TSPAN31 773 CDK4/MARCH9/C3HC4 774 LEMD3 775 IRAK3 776 TMTC3 777
ACTR6 778 TCTN1 779 PXMP2//PGAM5 780 DCP1B 781 SLC2A3//SLC2A14 782
C3AR1 783 PLBD1 784 TM7SF3 785 ASB8//PHB 786 LMBR1L 787
FMNL3//PRPF40B 788 AAAS 789 NFE2 790 GPR84 791 CD63 792
SARNP//DNAJC14 793 NACA 794 CDK4//TSPAN31 795 TMBIM4//LOC100133322
796 IL22 797 LIN7A 798 HAL 799 APPL2 800 GLTP 801 GIT2 802 VPS29
803 PPTC7 804 DDX54//CCDC42B 805 SLC24A6 806 SDS 807 RBM19 808
MED13L 809 C12orf49 810 FBXO21 811 WSB2 812 TAOK3 813 CIT 814 RAB35
815 RPLP0 816 PXN 817 TRIAP1 818 SFRS9 819 POP5 820 UNQ1887 821
C12orf43 822 ANAPC5 823 KDM2B 824 MORN3 825 TMEM120B//RHOF 826
LOC338799 827 DIABLO//B3GNT4 828 VPS33A 829 CLIP1 830 PITPNM2 831
EIF2B1 832 CCDC92 833 NCOR2 834 DHX37 835 DDX51 836 POLE 837 GOLGA3
838 ZMYM2 839 SPATA13//C1QTNF9 840 NUPL1 841 PAN3//EEF1A1//CHCHD2
842 ALOX5AP 843 EEF1DP3 844 KL 845 UFM1 846 NARG1L 847 ITM2B 848
FNDC3A 849 CDADC1 850 ARL11 851 LMO7 852 DNAJC3 853 TM9SF2 854
CLYBL 855 PCCA 856 ABHD13 857 LAMP1 858 TMCO3 859 UPF3A 860
ZMYM5//ZMYM2 861 ZDHHC20//LOC728099 862 PARP4 863 MTMR6//LOC646482
864 HSPH1 865 N4BP2L2//CG030 866 ELF1 867 LCP1 868 KPNA3 869
C13orf1 870 DLEU2//DLEU2L 871 GUCY1B2 872 INTS6 873 DACH1 874
TBC1D4 875 EDNRB 876 UGGT2 877 GPR183 878 LIG4 879 ANKRD10 880
RASA3 881 RNASE2//LOC643332 882 RPGRIP1 883 IRF9 884 TSSK4 885
C14orf21 886 SCFD1 887 FANCM 888 ABHD12B 889 PTGDR 890
FBXO34//KIAA0831 891 C14orf101 892 ACTR10 893 ARID4A 894 JKAMP 895
HIF1A 896 SYNE2 897 EXD2 898 SLC39A9 899 SFRS5 900 PCNX 901
SIPA1L1//SNORD56B// 902 LOC145474//LOC283567 YLPM1 903 BATF 904
FLVCR2//RPS24 905 GPR65 906 TDP1 907 EVL 908 ZNF839 909 TDRD9 910
INF2 911 PLD4 912 MTA1//LOC647310// 913 LOC100128343 NDRG2 914
DAD1//OR6J1 915 SLC7A8 916 IPO4 917 TM9SF1 918 ADCY4 919 RIPK3 920
EAPP 921 BAZ1A 922 NFKBIA 923 SEC23A 924 C14orf104 925 C14orf138
926 SOS2 927 NIN 928 PYGL 929 CNIH 930 DHRS7 931 WDR89 932 ACTN1
933 NUMB 934 C14orf43 935 ABCD4 936 KIAA0317 937 NEK9 938 ANGEL1
939 SPTLC2 940 SERPINA6 941 DICER1 942 BCL11B 943 ANKRD9 944
PPP1R13B 945 AKT1 946 BRF1 947 TUBGCP5 948 SNRPN * 949 APBA2 950
MTMR15//MTMR10 951 RYR3 952 BAHD1 953 CHP 954 JMJD7-PLA2G4B// 955
JMJD7//PLA2G4B HAUS2 956 C15orf63//SERF2 957 B2M 958 TRIM69 959
PLDN 960 SQRDL 961 GALK2 962 USP8 963 GLDN 964 MAPK6 965 LACTB 966
RAB8B 967 APH1B 968 USP3//LOC100130855 969 SNX1 970
LBXCOR1//PIAS1// 971 CALML4 NEO1 972
MPI 973 FBXO22//FBXO22OS 974 RCN2 975 FAH 976 IL16 977 ABHD2 978
SLCO3A1 979 MCTP2 980 MEF2A//LYSMD4 981 NIPA2//CYFIP1 982
HERC2//HERC2P2// 983 HERC2P3//LOC440248 MTMR10//MTMR15 984 C15orf24
985 SLC12A6 986 LPCAT4 987 INO80 988 OIP5 989 ZFP106 990 CDAN1 991
SPG11//ISLR 992 SPPL2A 993 GNB5//LOC100129973 994 MYO5A 995 ARPP19
996 RAB27A 997 CCPG1//PIGB//DYX1C1 998 BNIP2 999 CA12 1000 FAM96A
1001 KIAA0101//CSNK1G1 1002 TLE3 1003 PARP6 1004 NPTN 1005 MAN2C1
1006 IMP3 1007 MTHFS 1008 ST20//C15orf37 1009 TMC3 1010 AP3B2 1011
C15orf40 1012 WDR73 1013 NTRK3 1014 DET1 1015 TM2D3 1016 WDR90 1017
RHOT2//FBXL16 1018 TMEM204 1019 CRAMP1L//HN1L 1020 MAPK8IP3 1021
TBL3 1022 TSC2 1023 KCTD5//PRO0461// 1024 PDPK1 CLUAP1 1025 DNASE1
1026 DNAJA3 1027 CP110 1028 C16orf62 1029 LYRM1 1030 METTL9 1031
EEF2K 1032 POLR3E 1033 PLK1 1034 PRKCB 1035 IL21R//LOC283888 1036
SULT1A2//SULT1A1 1037 ATXN2L 1038 LAT .sup. 1039 KIF22 1040 MAZ
1041 CORO1A//LOC606724 1042 ITGAL 1043 SRCAP//SNORA30 1044
ZNF646//ZNF668 1045 C16orf67 1046 TMEM188 1047 LPCAT2 1048 CETP
1049 CKLF 1050 CMTM1//CKLF 1051 TMEM208 1052 CTCF 1053 THAP11 1054
NUTF2 1055 EDC4 1056 SLC7A6//SLC7A6OS 1057 PRMT7 1058 SNTB2 1059
VPS4A 1060 DDX19B//DDX19A 1061 CHST4 1062 HP//HPR 1063 PLCG2 1064
KLHL36 1065 KIAA0182 1066 BANP//RUNDC2C 1067 TRAPPC2L 1068 SPG7
1069 CDK10 1070 TCF25 1071 AFG3L1 1072 LUC7L 1073 AXIN1 1074 JMJD8
1075 LMF1 1076 UNKL 1077 UNKL 1078 CLCN7 1079 MRPS34 1080 RNPS1
1081 NLRC3 1082 TRAP1//DNASE1 1083 ADCY9 1084 CORO7 1085 C16orf72
1086 RRN3//LOC653390// 1087 LOC730092// LOC100131998
XYLT1//LYRM2//ZC3H11A 1088 DCUN1D3//LYRM1 1089 IGSF6//METTL9 1090
CDR2//RRN3// 1091 LOC100131998// LOC653390 COG7 1092 GGA2 1093
NSMCE1 1094 GTF3C1 1095 CCDC101//LOC388242 1096 C16orf54 1097
KCTD13 1098 SEPT1 1099 ZNF764//ZNF747 1100 C16orf58//LOC100128371
1101 ITFG1 1102 ABCC11//LONP2 1103 NUDT21 1104 BBS2//OGFOD1 1105
CSNK2A2 1106 GOT2 1107 FAM96B 1108 FHOD1//SLC9A5 1109
ATP6V0D1//LOC100132855 1110 GFOD2 1111 SLC12A4 1112 DPEP3 1113
DPEP2 1114 CHTF8//HAS3 1115 COG8//PDF 1116 TERF2 1117 AARS 1118
ST3GAL2 1119 VAC14//LOC100130894 1120 AP1G1 1121 WDR59 1122
CTRB2//CTRB1 1123 TAF1C//ADAD2 1124 FBXO31 1125 ZCCHC14 1126 FAM38A
1127 CENPBD1 1128 TIMM22 1129 RPA1 1130 DPH1//OVCA2 1131 SGSM2 1132
ARRB2 1133 LOC100130950 1134 DNAH2 1135 PIGL 1136 TRPV2 1137 MPRIP
1138 DRG2 1139 ALKBH5//FLJ13773 1140 SMCR7 1141 WSB1 1142 TAOK1
1143 CPD 1144 SUZ12P 1145 RNF135 1146 ZNF830 1147 TAF15 1148 GGNBP2
1149 LASP1 1150 PSMD3 1151 CDC6 1152 NBR2 1153 TMUB2 1154
MGC57346//C17orf69 1155 NSF//LOC728806 1156 GOSR2 1157
NPEPPS//TBC1D3F// 1158 LOC440434 KPNB1 1159 CDK5RAP3 1160 ATP5G1
1161 UBE2Z 1162 XYLT2//LOC100130580 1163 NOG 1164 DGKE 1165 AKAP1
1166 TMEM49//CLTC//MIR21 1167 CLTC 1168 CA4 1169 C17orf64 1170
DCAF7 1171 PITPNC1 1172 NOL11//SNORA38B 1173 MAP2K6 1174 COG1 1175
CD300A 1176 TMEM104 1177 MRPS7 1178 KIAA0195 1179 TSEN54 1180 LLGL2
1181 LOC100134934//CDK3 1182 MFSD11 1183 SEPT9 1184 TNRC6C 1185
TMC8 1186 ENGASE 1187 RPTOR 1188 GPS1 1189 FN3KRP 1190 TBCD 1191
GEMIN4 1192 GLOD4 1193 SLC43A2 1194 PRPF8 1195 SMG6//C17orf6 1196
METT10D//LOC284009 1197 SHPK 1198 TAX1BP3 1199 P2RX5 1200
MYBBP1A//SPNS2 1201 PELP1 1202 PFN1 1203 ZNF232 1204 DHX33 1205
DERL2 1206 NLRP1//LOC728392 1207 ASGR2 1208 NEURL4//GPS2//D4S234E
1209 ZBTB4 1210 TP53 1211 VAMP2 1212 PIK3R5 1213 ELAC2 1214
NCOR1//C20orf191// 1215 LOC100131704
ZNF287 1216 TOM1L2//LOC246315 1217 GRAP//SNORD3B-1// 1218
SNORD3B-2//LOC400581 ALDOC 1219 SDF2 1220 RAB34 1221 PHF12 1222
NUFIP2 1223 OMG 1224 EVI2B 1225 C17orf66//RSL24D1 1226
SYNRG//LOC100131822 1227 PLXDC1 1228 CACNB1 1229 PGAP3 1230 MED24
1231 NR1D1//THRA 1232 CCR7 1233 STAT5B//STAT5A 1234 FAM134C 1235
VAT1 1236 DUSP3 1237 C17orf65//ASB16 1238 UBTF 1239 GPATCH8 1240
MAP3K14//LOC100133991 1241 OSBPL7 1242 SLC35B1 1243 TOB1 1244
COX11//TOM1L1 1245 VEZF1 1246 SFRS1//FLJ44342 1247 SEPT4 1248
MED13//LOC100129112 1249 LIMD2//MAP3K3 1250 STRADA 1251 FTSJ3 1252
CD79B 1253 ICAM2 1254 ERN1 1255 TEX2 1256 LRRC37A3//LRRC37A2// 1257
LRRC37A//ARL17P1// LRRC37A4// LOC100294335//LOC644397 GNA13 1258
WIPI1//ARSG 1259 FAM20A 1260 NAT9 1261 GGA3 1262 H3F3B//H3F3C 1263
EXOC7 1264 SFRS2 1265 TMC6//LOC100131096 1266 USP36 1267 CD7 1268
RAB31 1269 VAPA 1270 SEH1L 1271 HQ0644/PRO0644 1272 RNMT 1273
RNF138 1274 GALNT1 1275 ELP2 1276 PIK3C3 1277 SLC14A2 1278 ME2 1279
SERPINB2//SERPINB10 1280 ZNF407 1281 ZNF236 1282
NFATC1//LOC100127994 1283 ENOSF1//TYMS 1284 MYOM1 1285 AFG3L2 1286
ABHD3 1287 OSBPL1A 1288 CDH2 1289 DSC1 1290 PSTPIP2 1291 C18orf32
1292 MBD2//SNORA37 1293 PIGN 1294 TMX3 1295 PQLC1 1296 GZMM 1297
ARID3A 1298 CIRBP 1299 DAZAP1 1300 SPPL2B 1301 NFIC 1302 VAV1 1303
ARHGEF18//LOC100128573 1304 STXBP2//LOC554363// 1305 LOC100131801
C19orf59 1306 ZNF317 1307 ILF3 1308 SMARCA4 1309 PRKCSH 1310 IER2
1311 CCDC130 1312 DCAF15 1313 IL27RA 1314 KLF2 1315 SIN3B 1316 DDA1
1317 GTPBP3 1318 FAM129C 1319 FCHO1 1320 ARRDC2 1321 IFI30 1322
C19orf60 1323 CRTC1//MAML2 1324 RFXANK//MEF2B//LOC729991 1325
ZNF101 1326 ZNF738 1327 ZNF257//ZNF492//ZNF99// 1328
ZNF98//LOC646864 C19orf2 1329 KIAA0355//FLJ21369 1330 USF2 1331
TMEM147 1332 LIN37//PSENEN 1333 C19orf55 1334 TBCB//POLR2I 1335
ZNF382 1336 ZNF568 1337 ZNF420 1338 ZNF383 1339 CCDC97 1340 ZNF574
1341 CD177 1342 ZNF230//ZNF222 1343 VASP 1344 GRWD1 1345 FLT3LG
1346 ZNF175 1347 NCRNA00085 1348 PPP2R1A 1349 ZNF808//ZNF578// 1350
ZNF611 LENG8 1351 FCAR 1352 RPL28 1353 U2AF2 1354
LOC100288114//MGC9913 1355 ZFP28 1356 ZNF460 1357 ZNF549 1358
ZNF211 1359 ZNF587//ZNF417 1360 ZNF274 1361 ZNF544 1362 ZNF8 1363
TRIM28 1364 C19orf6 1365 C19orf34 1366 GNG7 1367 AES 1368
EEF2//SNORD37 1369 PLIN5//LRG1 1370 PLIN3 1371 PTPRS 1372
SAFB2//SAFB 1373 RANBP3 1374 GTF2F1//LOC100130856 1375 XAB2 1376
ELAVL1 1377 ADAMTS10 1378 FBXL12 1379 DNMT1 1380 TYK2 1381 KEAP1
1382 KRI1 1383 TMEM205//hCG_29977 1384 ZNF563 1385 MAN2B1//MORG1
1386 C19orf56 1387 DHPS 1388 TNPO2//SNORD41 1389 LPHN1 1390 NDUFB7
1391 AKAP8 1392 AKAP8L 1393 CHERP//C19orf44// 1394 CALR3
INSL3//JAK3 1395 IL12RB1 1396 UPK1A 1397 TYROBP 1398 ZNF529 1399
ZNF461 1400 ZNF607 1401 YIF1B 1402 PRR13 1403 CEACAM4 1404 PLAUR
1405 TRAPPC6A 1406 ERCC1//CD3EAP 1407 RTN2 1408 SYMPK 1409 PGLYRP1
1410 NOSIP 1411 PNKP 1412 NKG7 1413 FPR1 1414 ZNF28 1415 OSCAR 1416
MBOAT7 1417 LILRA5 1418 LILRA4 1419 ZNF550//ZNF549 1420 ZNF416 1421
ZNF256 1422 ZNF329 1423 FAM110A 1424 ITPA 1425 CDC25B 1426 CDS2
1427 CRLS1 1428 CSRP2BP 1429 SEC23B 1430 SLC24A3 1431 HCK 1432
ASXL1 1433 ACSS2 1434 C20orf4 1435 TGIF2 1436 C20orf24//SLA2 1437
RPN2//EEF1A2 1438 CTNNBL1 1439 ACTR5 1440 PPP1R16B 1441 DHX35 1442
PLCG1 1443 MYBL2 1444 SYS1//SYS1- 1445 DBNDD2//DBNDD2 DNTTIP1 1446
CTSA 1447 MMP9//LOC100128028 1448 DDX27 1449 SLC9A8 1450 RNF114
1451 PTPN1 1452 TSHZ2 1453 PFDN4 1454 CSTF1 1455 CASS4 1456 GNAS
1457
C20orf177 1458 CDH26 1459 C20orf197 1460 LOC284757 1461 ARFGAP1
1462 PRPF6 1463 NSFL1C 1464 SIRPD 1465 SIRPG//SIRPA 1466 RNF24 1467
RASSF2 1468 TMX4 1469 JAG1 1470 C20orf74 1471 C20orf3 1472
C20orf112 1473 CDK5RAP1 1474 AHCY 1475 GGT7 1476 EDEM2 1477
RBM39//LOC643167 1478 BLCAP 1479 SERINC3//TTPAL 1480 ZNF335 1481
ELMO2 1482 B4GALT5 1483 DPM1 1484 ZFP64 1485 ZNF217 1486 CTSZ 1487
SYCP2 1488 PSMA7 1489 DIDO1 1490 YTHDF1 1491 CHODL 1492 BACH1 1493
C21orf41//BACH1 1494 IL10RB 1495 IFNAR1 1496 IFNGR2 1497 SON 1498
MORC3//DOPEY2 1499 DYRK1A 1500 KCNJ15 1501 ETS2 1502 RRP1B 1503
PFKL 1504 TRPM2 1505 ADARB1 1506 SAMSN1//LOC388813 1507 N6AMT1 1508
SYNJ1 1509 TMEM50B 1510 KCNE1 1511 PRDM15 1512 C2CD2 1513 WDR4 1514
U2AF1 1515 CSTB 1516 UBE2G2//SUMO3 1517 PTTG1IP 1518 POFUT2 1519
MCM3AP 1520 IL17RA//CECR7 1521 C22orf37 1522 LZTR1 1523
PPIL2//YPEL1 1524 CYTSA 1525 SNRPD3//C22orf13 1526 NF2 1527 LIMK2
1528 SLC5A1 1529 MCM5 1530 NCF4 1531 GGA1 1532 SH3BP1//PDXP 1533
POLR2F//LOC100131530 1534 APOBEC3A//APOBEC3B 1535 APOBEC3D 1536
ATF4 1537 CACNA1I 1538 ZC3H7B 1539 CCDC134 1540 TSPO 1541 NUP50
1542 TBC1D22A//LOC100289878 1543 RP3-402G11.5 1544 SAPS2 1545
NCAPH2 1546 BID 1547 SLC25A1 1548 KLHL22//KRT18 1549
PI4KA//PI4KAP1// 1550 PI4KAP2//LOC100293141 MAPK1 1551 ZNF70 1552
TPST2 1553 SF3A1//CCDC157 1554 PES1 1555 PIK3IP1 1556 PATZ1 1557
C22orf30 1558 IL2RB 1559 CSNK1E//LOC400927 1560 UNC84B 1561
CBX7//LOC100128400 1562 RPS19BP1 1563 MKL1//KIAA1659 1564 RANGAP1
1565 TCF20 1566 LDOC1L 1567 UNQ6126 1568 TUBGCP6 1569 SBF1//SBF1P1
1570 MSL3 1571 MOSPD2 1572 BMX//HNRPDL 1573 PDHA1 1574 YY2 1575
PDK3 1576 GK//GK3P//FTL// 1577 LOC652904 CXorf59 1578 ATP6AP2 1579
USP9X//USP9Y 1580 RP2 1581 USP11 1582 RBM3 1583 FTSJ1 1584 WAS 1585
PLP2 1586 TSPYL2//GPR173 1587 MAGED2 1588 UBQLN2 1589 NLGN3 1590
ACRC 1591 UPRT 1592 CXorf26 1593 ATP7A 1594 DIAPH2 1595
CSTF2//RAD21 1596 ARMCX3 1597 ARMCX5 1598 GPRASP1 1599 TMEM31 1600
TBC1D8B 1601 MID2 1602 DOCK11 1603 LONRF3 1604 UBE2A 1605 SH2D1A
1606 OCRL 1607 SLC25A14 1608 HPRT1 1609 CD40LG 1610 AFF2 1611
SSR4//IDH3G 1612 FAM50A 1613 DKC1//SNORA36A// 1614 SNORA56 ARSD
1615 KAL1 1616 CTPS2 1617 RPS6KA3 1618 BCOR 1619 MAOB//NAT13 1620
ZNF41 1621 OTUD5 1622 KCND1 1623 ZMYM3 1624 MAGT1 1625 BRWD3 1626
TRMT2B 1627 GLA 1628 MORF4L2 1629 PSMD10 1630 ACSL4 1631 LAMP2 1632
CUL4B 1633 ODZ1 1634 ELF4 1635 RAP2C 1636 FAM127B//FAM127C// 1637
FAM127A TMEM185A 1638 ARD1A 1639 IRAK1 1640 DNASE1L1//RPL10 1641
SH3KBP1 1642 Mitochondrial1 1643 Mitochondrial2 1644 CCNL2 1645
INPP5B 1646 TLR5 1647 ADRB3//GOT1L1 1648 NOC2L//SAMD11// 1649
LOC401010 SHFM1 1650 .sup..sctn. HUGO Gene Nomenclature Committee
.sup. Synonymous with
SPNS1//NPIPL2//LOC728741//LOC730153//NPIPL3//SPIN1//LOC728888//LOC1002891-
69//LOC728734//LOC729602//LOC100288442//LOC100288332 * Synonymous
with
SNURF//IPW//SNORD116-16//SNORD116-18//SNORD116-21//SNORD116-22//SNORD116--
17//SNORD116-19//PAR5//PAR-SN//SNORD116-2//SNORD116-25//SNORD116-26//SNORD-
107//SNORD115-12//SNORD115-5//SNORD115-6//SNORD115-9//SNORD116-11//SNORD11-
6-12//SNORD116-13//SNORD116-28//SNORD116-4//SNORD64//PAR1//SNORD109A//SNOR-
D109B//SNORD116-6//SNORD116-3//SNORD116-9//SNORD115-13//SNORD115-1//SNORD1-
15-14//SNORD115-15//SNORD115-21//SNORD115-10//SNORD115-7//SNORD115-16//SNO-
RD115-40//SNORD115-42//SNORD115-11//SNORD115-29//SNORD115-34//SNORD115-36/-
/SNORD115-4//SNORD115-43//HBII-52-24//SNORD116-5//SNORD116-7//SNORD115-26/-
/SNORD115-30//SNORD116-15//SNORD116-8//SNORD115-2//SNORD115-39//SNORD116-1-
4//SNORD116-20//SNORD115-8//SNORD115-3//SNORD115-38//SNORD115-41//SNORD115-
-22//SNORD115-44//SNORD116-1//SNORD115-17//SNORD115-18//SNORD115-19//SNORD-
115-20//SNORD116@
TABLE-US-00006 TABLE 2 HGNC .sup..sctn. Gene SEQ Name ID NO PRKCZ
1651 SKI 1652 RER1 1653 TAS1R1 1654 VAMP3 1655 AGTRAP 1656 VPS13D
1657 KLHDC7A 1658 NBL1//C1orf151 1659 MDS2 1660 RCAN3 1661 LDLRAP1
1662 MAN1C1 1663 SH3BGRL3 1664 DHDDS 1665 HCRTR1 1666 CCDC28B 1667
LCK 1668 ZNF362 1669 THRAP3 1670 PPIE//CCDC25 1671 CAP1 1672 CTPS
1673 C1orf84 1674 FAAH 1675 DMBX1 1676 CYP4B1 1677 BTF3L4 1678
LRRC42 1679 C1orf175//TTC4 1680 TMEM61 1681 FPGT//TNNI3K 1682 ACADM
1683 SPATA1 1684 EPHX4 1685 RPAP2 1686 RPL5//SNORA66// 1687
SNORD21//FAM69A RTCD1 1688 SLC30A7 1689 RNPC3//AMY2B 1690 CELSR2
1691 AHCYL1 1692 CEPT1//DRAM2 1693 CHIA 1694 LIX1L 1695 UPF0627
1696 MRPS21 1697 TNFAIP8L2 1698 SMCP 1699 DCST1 1700 RAG1AP1 1701
C1orf182 1702 HAPLN2 1703 NTRK1 1704 CD1E 1705 TOMM40L//NR1I3 1706
POU2F1 1707 TIPRL 1708 SFT2D2 1709 CACNA1E 1710 SMG7 1711 OCLM 1712
RGS2 1713 ZC3H11A//RP11-74E24.2 1714 MFSD4 1715 IL20 1716 RPS6KC1
1717 C1orf95 1718 ARF1 1719 GALNT2 1720 TNFRSF4 1721 NADK 1722
FLJ14100//C1orf86 1723 GPR153 1724 RERE 1725 SLC2A7 1726 SDHB 1727
RNF186 1728 DDOST 1729 GPN2 1730 RPA2 1731 PEF1 1732 PTP4A2 1733
TRIM62 1734 PHC2 1735 LSM10 1736 MRPS15 1737 RRAGC 1738 COL9A2 1739
TESK2 1740 NRD1 1741 KTI12 1742 CC2D1B 1743 YIPF1 1744 JAK1 1745
SLC35D1 1746 DIRAS3 1747 ZZZ3 1748 GNG5 1749 ZNHIT6 1750 ODF2L 1751
SEP15 1752 BARHL2 1753 GCLM 1754 CLCC1//GPSM2//C1orf62 1755 SORT1
1756 SLC16A4 1757 PHTF1 1758 RSBN1 1759 DENND2C//BCAS2 1760 CD58
1761 SPAG17//WDR3 1762 REG4//NBPF7 1763 RP11-94I2.2//NBPF16// 1764
NBPF11//NBPF15//NBPF8// NBPF20//NBPF10//NBPF14//
NBPF1//LOC100288142// NBPF12//KIAA1245// LOC100290137 APH1A 1765
POGZ 1766 TDRKH 1767 THEM4 1768 S100A11 1769 CRNN 1770 SPRR2C
S100A12 1771 S100A8 1772 GATAD2B//PLIN2 1773 DENND4B 1774 PBXIP1
1775 PYGO2 1776 SHC1 1777 DCST2 1778 GBA//GBAP 1779 ASH1L 1780 RIT1
1781 MEF2D 1782 AIM2 1783 COPA 1784 DEDD 1785 TADA1L 1786 GPA33
1787 CD247 1788 F5 1789 PIGC 1790 KIAA0040 1791
TOR1AIP2//TOR1AIP1//IFRG15 1792 STX6//KIAA1614 1793 EDEM3 1794
UCHL5 1795 DENND1B 1796 DDX59 1797 KIF21B 1798 ARL8A 1799 CYB5R1
1800 MYBPH 1801 CHI3L1 1802 PIK3C2B//LOC100130573 1803 NUAK2 1804
NUCKS1 1805 FAIM3 1806 PLXNA2 1807 SLC30A1 1808 LPGAT1 1809 ANGEL2
1810 RAB3GAP2//AURKAPS1// 1811 AURKA//SNORA36B TP53BP2 1812 NVL
1813 TMEM63A 1814 PARP1 1815 ITPKB 1816 TARBP1 1817 CHML 1818 AKT3
1819 SMYD3 1820 AHCTF1 1821 OR1C1 1822 NCOA1 1823 HADHB 1824
ABHD1//PREB 1825 SPAST 1826 SLC30A6//DDX50 1827 CRIPT 1828 MSH2
1829 FOXN2 1830 CCDC104 1831 VRK2 1832 AHSA2//USP34 1833 OTX1 1834
AFTPH 1835 CEP68 1836 PLEK 1837 ANXA4 1838 MXD1 1839 NAGK 1840
SMYD5//NOTO 1841 MTHFD2 1842 TTC31 1843 SEMA4F 1844 TMSB10 1845
SH2D6 1846 GNLY 1847 KCNIP3 1848 CNNM4 1849 CNNM3 1850 ZAP70 1851
LIPT1//MRPL30 1852 MAP4K4 1853 IL1R2 1854 IL1R1 1855 IL18R1 1856
POLR1B 1857 CHCHD5 1858 IL1RN 1859 PSD4 1860 DDX18 1861 INSIG2 1862
TMEM177//LOC100125918 1863 RALB 1864 PROC 1865
GPR17//LOC100291428//LIMS2 1866 IMP4 1867 FAM123C 1868 ACVR2A 1869
MBD5 1870 LYPD6B 1871 SLC4A10 1872 UBR3 1873 HAT1 1874 ITGA6 1875
ZAK 1876 OSBPL6 1877 PLEKHA3 1878 ZC3H15 1879 COL3A1 1880 GLS 1881
OBFC2A 1882 COQ10B 1883 MARS2 1884 CFLAR 1885 NOP58 1886 FAM117B
1887
CYP20A1 1888 FASTKD2 1889 PIKFYVE 1890 C2orf62 1891 SLC11A1 1892
AGFG1 1893 CHRNG 1894 EIF4E2 1895 TRPM8 1896 LRRFIP1 1897 GAL3ST2
1898 TMEM18 1899 LAPTM4A 1900 SF3B14 1901 TP53I3 1902 UNQ2999 1903
GPR113//SELI 1904 MPV17 1905 PPM1G 1906 NLRC4 1907 CDC42EP3 1908
HNRPLL 1909 COX7A2L 1910 KCNG3 1911 CALM2//C2orf61 1912 BCL11A 1913
XPO1 1914 NAT8B 1915 DUSP11 1916 MOGS 1917 SNRNP200 1918 SEMA4C
1919 MITD1 1920 IL1A 1921 SLC35F5 1922 CCDC93 1923 CLASP1 1924
SAP130 1925 YSK4 1926 GTDC1 1927 ORC4L 1928 NR4A2//FLJ46875 1929
DPP4 1930 GALNT3 1931 SCN7A 1932 FRZB 1933 STK17B 1934 CLK1//PPIL3
1935 MPP4 1936 INO80D 1937 KLF7 1938 FAM119A 1939 NGEF 1940 ARL4C
1941 RAB17 1942 HDLBP 1943 LRRN1 1944 SETD5 1945 IRAK2 1946 C3orf42
1947 TSEN2 1948 NR2C2//MRPS25 1949 UBE2E1 1950 C3orf35 1951 SNRK
1952 ZNF197 1953 GNAI2 1954 ALAS1 1955 PRKCD 1956 CACNA1D 1957 PXK
1958 PTPRG 1959 ATXN7 1960 SLC35A5 1961 SLC15A2 1962 CCDC48 1963
DNAJC13 1964 CLDN18 1965 GYG1 1966 SELT 1967 MED12L 1968 RAP2B 1969
MYNN 1970 ABCF3 1971 VPS8 1972 HRG 1973 EIF4A2//SNORA4 1974 LPP
1975 CCDC50 1976 LOC152217 1977 TADA3L 1978 SEC13 1979 TIMP4 1980
METTL6 1981 DAZL//DAZ4//DAZ3//DAZ2 1982 SATB1//TBC1D5 1983 SCN10A
1984 SEC22C 1985 ZDHHC3 1986 ZDHHC3 1987 SLC6A20 1988 UQCRC1 1989
PRKAR2A 1990 IMPDH2 1991 CCDC71 1992 UBA7 1993 CAMKV 1994 WDR82
1995 LMOD3 1996 FOXP1 1997 MORC1 1998 ATG3 1999 GSK3B//LOC100129275
2000 HCLS1 2001 KPNA1 2002 PTPLB 2003 C3orf22 2004 RPN1 2005
KIAA1257//ACAD9// 2006 LOC100132731 FOXL2 2007 MECOM 2008 PLD1 2009
GNB4 2010 MRPL47 2011 KLHL6 2012 THPO 2013 ETV5 2014
BCL6//LOC100131635 2015 ATP13A5 2016 TMEM44 2017 KIAA1530 2018
TACC3 2019 CNO 2020 BST1 2021 KLF3 2022 TMEM33//DCAF4L1 2023 KIT
2024 ENAM 2025 FAM47E//STBD1 2026 ENOPH1 2027 PDLIM5 2028
CCDC109B//HIGD1A//CCDC13 2029 EGF 2030 PCDH10 2031 RAB33B 2032
TMEM184C 2033 RBM46 2034 GRIA2 2035 C4orf39 2036 KLHL2 2037 TLL1
2038 F11 2039 SLBP 2040 HAUS3//POLN 2041 PPARGC1A 2042 TLR10 2043
C4orf34 2044 TXK 2045 RPL21P44 KDR 2046 RCHY1 2047 CNOT6L 2048
PLAC8 2049 HPSE 2050 GPRIN3 2051 PPA2 2052 COL25A1 2053 C4orf3 2054
QRFPR 2055 MFSD8 2056 MAP9 2057 PDGFC 2058 TKTL2 2059 ACSL1 2060
SUB1//TMEM183A 2061 CARD6 2062 MCCC2 2063 TNPO1 2064 PDE8B 2065
PAPD4 2066 THBS4 2067 FAM151B 2068 RASGRF2 2069 SNX2 2070
LMNB1//PCIF1 2071 MEGF10 2072 LEAP2 2073 TCF7 2074 KDM3B 2075 CXXC5
2076 SLC4A9 2077 ANKHD1-EIF4EBP3// 2078 ANKHD1//EIF4EBP3 KIAA0141
2079 GRPEL2 2080 MFAP3 2081 GABRA6 2082 GABRA1 2083 DOCK2 2084
RANBP17//USP12 2085 ERGIC1 2086 ATP6V0E1//SNORA74B ZNF346 2087 NSD1
2088 CLPTM1L 2089 UGT3A1 2090 GDNF 2091 TTC33 2092 hCG_2039148
MOCS2 2093 SLC38A9 2094 CCDC125 2095 ANKRA2 2096 HAPLN1 2097 CCNH
2098 TMEM161B 2099 MBLAC2 2100 MCTP1 2101 TICAM2//TMED7// 2102
TMED7-TICAM2 KIF3A 2103 C5orf15 2104 SKP1 2105 CXCL14 2106 KLHL3
2107 CD14 2108 YIPF5 2109 LARS 2110 DCTN4 2111 CCDC69 2112 ATOX1
2113 TIMD4 2114 ADAM19 2115 SLIT3 2116 RNF44 2117 DOK3 2118
MGAT4B//SQSTM1 2119 C5orf45//SQSTM1 2120 RASGEF1C 2121 MGAT1 2122
IRF4 2123 HIVEP1 2124 E2F3 2125 HIST1H4I 2126 HIST1H2BM 2127 MOG
2128 ZNRD1//NCRNA00171 2129 TRIM15 2130 HCG27 2131 BAT2//SNORA38
2132
CYP21A2 2133 ITPR3 2134 MAPK14 2135 MAPK13 2136 PNPLA1 2137 SFRS3
2138 CDKN1A 2139 FOXP4 2140 CUL9 2141 RUNX2 2142 ZNF451 2143 SOBP
2144 C6orf182 2145 KIAA1919 2146 RWDD1 2147 KPNA5 2148 TPD52L1 2149
ARG1 2150 RAB32 2151 ARID1B 2152 SLC22A3 2153 SERPINB1 2154
C6orf146 2155 GCM2 2156 ATXN1 2157 DCDC2//KAAG1 2158 HIST1H3I 2159
HIST1H4L 2160 GABBR1 2161 RNA243 DDAH2 2162 CLIC1 2163 NEU1 2164
RXRB 2165 VPS52 2166 TCP11 2167 CLPS 2168 PGC 2169 ZNF318 2170
YIPF3 2171 MRPL14 2172 PLA2G7 2173 PKHD1 2174 IL17F 2175 HTR1B 2176
GABRR2 2177 UBE2J1 2178 BACH2 2179 MCM9 2180 VNN1 2181 IL20RA 2182
FLJ27255 2183 T 2184 RPS6KA2 2185 HGC6.3 2186 UNC84A//C7orf20 2187
SDK1 2188 ZDHHC4 2189 C7orf26 2190 GLCCI1//tcag7.903 2191 GPNMB
2192 CCDC126 2193 WIPF3//ZNRF2//LOC441208 2194 GPR141 2195 STARD3NL
2196 POU6F2 2197 CDC2L5 2198 ZMIZ2 2199 UPP1 2200 ZNF273 2201
KCTD7//RABGEF1 2202 RABGEF1//tcag7.967// 2203 tcag7.951//KCTD7//
LOC100293333 CCDC132 2204 PVRIG//PILRB//STAG3 2205
PILRB//PVRIG//STAG3 2206 C7orf51 2207 GNB2 2208 LRRC17 2209 LRRN3
2210 CFTR 2211 LSM8 2212 LUC7L2 2213 MGAM//LOC100124692 2214 GIMAP7
2215 INSIG1 2216 RBM33 2217 ICA1 2218 FAM126A 2219 HIBADH 2220 TRIL
2221 SCRN1 2222 ELMO1 2223 INHBA 2224 CAMK2B 2225 NPC1L1 2226
DDC//LOC100129427 2227 NSUN5//NSUN5B//NSUN5C 2228 CLDN3 2229
C7orf23//DMTF1 2230 SRI 2231 BET1 2232 MCM7 2233 GATS 2234
ATXN7L1//RINT1//EFCAB10 2235 KIAA1549 2236 SLC37A3 2237 SMARCD3
2238 MLL3//BAGE2 2239 CLN8 2240 MSRA 2241 PIWIL2 2242
NEFM//LOC100129717 2243 EPHX2 2244 LEPROTL1 2245 MAK16//C8orf41
2246 AP3M2 2247 FNTA 2248 SGK196 2249 UBE2V2 2250 FLJ46365 N/A
SNTG1 2251 TRIM55 2252 C8orf45 2253 PREX2 2254 PLEKHF2 2255
BAALC//FLJ10489 2256 TTC35 2257 MTBP 2258 ZHX2 2259 RNF139 2260 TG
2261 DENND3//C8orf60 2262 TNFRSF10D 2263 TRIM35 2264 GSR 2265
WHSC1L1 2266 PCMTD1//PXDNL 2267 NCOA2 2268 TRAM1//LOC286190 2269
RUNX1T1 2270 EXT1 2271 DDEF1IT1 2272 CDC37L1 2273 UBE2R2 2274
UBAP1//KIF24 2275 GALT 2276 RGP1//GBA2 2277 TGFBR1 2278
C9orf6//IKBKAP 2279 IMAGE5303689 N/A ATP6V1G1 2280 TLR4 2281 SET
2282 MRPL41 2283 C9orf68 2284 HAUS6//SCARNA8 2285 KLHL9 2286
C9orf82 2287 NDUFB6//DFFB 2288 SIT1 2289 FAM108B1 2290 TRPM6 2291
FRMD3 2292 SLC28A3 2293 BICD2 2294 C9orf84 2295 AKNA 2296 MEGF9
2297 C5 2298 GOLGA1//SCAI 2299 SH2D3C 2300 FAM102A 2301 FLJ10232
N/A ASB6 2302 BAT2L 2303 EDF1 2304 FBXW5 2305 C10orf18 2306 FBXO18
2307 GATA3 2308 CUGBP2 2309 VIM 2310 STAM 2311 WAC 2312 BAMBI 2313
ZNF487//LOC439911 2314 ALOX5 2315 WDFY4 2316 SRGN 2317 CCDC109A
2318 FAM149B1//FAM149B2 2319 MINPP1 2320 PTEN//PTENP1 2321
ENTPD1//C10orf131 2322 ABCC2 2323 SFXN2 2324 SHOC2 2325 ACSL5 2326
BCCIP//DHX32 2327 FAM188A 2328 CUBN 2329 SVIL//hCG_1783494 2330
FAM13C//PHYHIPL 2331 ATAD1 2332 ANKRD22 2333 FLJ34077 N/A COX15
2334 ERLIN1 2335 ACTR1A 2336 ABLIM1 2337 RAB11FIP2 2338 C10orf84
2339 PRDX3 2340 C10orf119 2341 NSMCE4A 2342 TALDO1//INTS8 2343
TNNT3 2344 FXC1 2345 PDE3B 2346 DNAJC24 2347 PTPRJ//OR4B1 2348
C11orf31 2349 TMEM109 2350 CD6 2351 CD5 2352 TMEM138 2353 POLR2G
2354 TMEM179B 2355 NAT11 2356 OTUB1 2357 RBM14//RBM4 2358 AIP 2359
PPFIA1 2360 IL18BP//NUMA1 2361 C11orf30 2362 C11orf82 2363 TMEM126B
2364 C11orf73 2365 PIWIL4 2366 LOC100132686 2367 PAFAH1B2 2368
UBE4A 2369 TRAPPC4 2370 SC5DL 2371 VWA5A//OR10D1P 2372 STT3A 2373
VPS26B 2374 TRIM21 2375 ZBED5 2376
SAAL1 2377 FANCF 2378 LIN7C 2379 PHF21A 2380 CUGBP1 2381 OSBP 2382
CYBASC3 2383 TUT1 2384 SLC25A45 2385 LTBP3 2386 EIF1AD 2387 GAB2
2388 CREBZF 2389 PICALM 2390 SLC36A4 2391 CCDC82 2392 KIAA1826 2393
MPZL3 2394 MPZL2 2395 H2AFX 2396 SIAE 2397 ZBTB44 2398 HSN2 2399
ADIPOR2 2400 NCAPD2//SCARNA10//FADS1 2401 PTPN6 2402 CLEC4D 2403
CDKN1B 2404 GOLT1B 2405 FAR2 2406 FGD4 2407 TMEM106C 2408 TMBIM6
2409 C12orf62 2410 PRR13//PCBP2 2411 DGKA 2412 COQ10A 2413 TSPAN31
2414 CDK4/MARCH9/C3HC4 2415 LEMD3 2416 IRAK3 2417 TMTC3 2418 ACTR6
2419 TCTN1 2420 PXMP2//PGAM5 2421 DCP1B 2422 SLC2A3//SLC2A14 2423
C3AR1 2424 PLBD1 2425 TM7SF3 2426 ASB8//PHB 2427 LMBR1L 2428
FMNL3//PRPF40B 2429 AAAS 2430 NFE2 2431 GPR84 2432 CD63 2433
SARNP//DNAJC14 2434 NACA 2435 CDK4//TSPAN31 2436
TMBIM4//LOC100133322 2437 IL22 2438 LIN7A 2439 HAL 2440 APPL2 2441
GLTP 2442 GIT2 2443 VPS29 2444 PPTC7 2445 DDX54//CCDC42B 2446
SLC24A6 2447 SDS 2448 RBM19 2449 MED13L 2450 C12orf49 2451 FBXO21
2452 WSB2 2453 TAOK3 2454 CIT 2455 RAB35 2456 RPLP0 2457 PXN 2458
TRIAP1 2459 SFRS9 2460 POP5 2461 UNQ1887 2462 C12orf43 2463 ANAPC5
2464 KDM2B 2465 MORN3 2466 TMEM120B//RHOF 2467 LOC338799
DIABLO//B3GNT4 2468 VPS33A 2469 CLIP1 2470 PITPNM2 2471 EIF2B1 2472
CCDC92 2473 NCOR2 2474 DHX37 2475 DDX51 2476 POLE 2477 GOLGA3 2478
ZMYM2 2479 SPATA13//C1QTNF9 2480 NUPL1 2481 PAN3//EEF1A1//CHCHD2
2482 ALOX5AP 2483 EEF1DP3 2484 KL 2485 UFM1 2486 NARG1L 2487 ITM2B
2488 FNDC3A 2489 CDADC1 2490 ARL11 2491 LMO7 2492 DNAJC3 2493
TM9SF2 2494 CLYBL 2495 PCCA 2496 ABHD13 2497 LAMP1 2498 TMCO3 2499
UPF3A 2500 ZMYM5//ZMYM2 2501 ZDHHC20//LOC728099 2502 PARP4 2503
MTMR6//LOC646482 2504 HSPH1 2505 N4BP2L2//CG030 2506 ELF1 2507 LCP1
2508 KPNA3 2509 C13orf1 2510 DLEU2//DLEU2L 2511 GUCY1B2 2512 INTS6
2513 DACH1 2514 TBC1D4 2515 EDNRB 2516 UGGT2 2517 GPR183 2518 LIG4
2519 ANKRD10 2520 RASA3 2521 RNASE2//LOC643332 2522 RPGRIP1 2523
IRF9 2524 TSSK4 2525 C14orf21 2526 SCFD1 2527 FANCM 2528 ABHD12B
2529 PTGDR 2530 FBXO34//KIAA0831 2531 C14orf101 2532 ACTR10 2533
ARID4A 2534 JKAMP 2535 HIF1A 2536 SYNE2 2537 EXD2 2538 SLC39A9 2539
SFRS5 2540 PCNX 2541 SIPA1L1//SNORD56B// 2542 LOC145474//LOC283567
YLPM1 2543 BATF 2544 FLVCR2//RPS24 2545 GPR65 2546 TDP1 2547 EVL
2548 ZNF839 2549 TDRD9 2550 INF2 2551 PLD4 2552 MTA1//LOC647310//
2553 LOC100128343 NDRG2 2554 DAD1//OR6J1 2555 SLC7A8 2556 IPO4 2557
TM9SF1 2558 ADCY4 2559 RIPK3 2560 EAPP 2561 BAZ1A 2562 NFKBIA 2563
SEC23A 2564 C14orf104 2565 C14orf138 2566 SOS2 2567 NIN 2568 PYGL
2569 CNIH 2570 DHRS7 2571 WDR89 2572 ACTN1 2573 NUMB 2574 C14orf43
2575 ABCD4 2576 KIAA0317 2577 NEK9 2578 ANGEL1 2579 SPTLC2 2580
SERPINA6 2581 DICER1 2582 BCL11B 2583 ANKRD9 2584 PPP1R13B 2585
AKT1 2586 BRF1 2587 TUBGCP5 2588 SNRPN * 2589 APBA2 2590
MTMR15//MTMR10 2591 RYR3 2592 BAHD1 2593 CHP 2594 JMJD7-PLA2G4B//
2595 JMJD7//PLA2G4B HAUS2 2596 C15orf63//SERF2 2597 B2M 2598 TRIM69
2599 PLDN 2600 SQRDL 2601 GALK2 2602 USP8 2603 GLDN 2604 MAPK6 2605
LACTB 2606 RAB8B 2607 APH1B 2608 USP3//LOC100130855 2609 SNX1 2610
LBXCOR1//PIAS1//CALML4 2611 NEO1 2612 MPI 2613 FBXO22//FBXO22OS
2614 RCN2 2615 FAH 2616 IL16 2617 ABHD2 2618 SLCO3A1 2619 MCTP2
2620 MEF2A//LYSMD4 2621 NIPA2//CYFIP1 2622 HERC2//HERC2P2//
2623
HERC2P3//LOC440248 MTMR10//MTMR15 2624 C15orf24 2625 SLC12A6 2626
LPCAT4 2627 INO80 2628 OIP5 2629 ZFP106 2630 CDAN1 2631 SPG11//ISLR
2632 SPPL2A 2633 GNB5//LOC100129973 2634 MYO5A 2635 ARPP19 2636
RAB27A 2637 CCPG1//PIGB//DYX1C1 2638 BNIP2 2639 CA12 2640 FAM96A
2641 KIAA0101//CSNK1G1 2642 TLE3 2643 PARP6 2644 NPTN 2645 MAN2C1
2646 IMP3 2647 MTHFS 2648 ST20//C15orf37 2649 TMC3 2650 AP3B2 2651
C15orf40 2652 WDR73 2653 NTRK3 2654 DET1 2655 TM2D3 2656 WDR90 2657
RHOT2//FBXL16 2658 TMEM204 2659 CRAMP1L//HN1L 2660 MAPK8IP3 2661
TBL3 2662 TSC2 2663 KCTD5//PRO0461//PDPK1 2664 CLUAP1 2665 DNASE1
2666 DNAJA3 2667 CP110 2668 C16orf62 2669 LYRM1 2670 METTL9 2671
EEF2K 2672 POLR3E 2673 PLK1 2674 PRKCB 2675 IL21R//LOC283888 2676
SULT1A2//SULT1A1 2677 ATXN2L 2678 LAT .sup. 2679 KIF22 2680 MAZ
2681 CORO1A//LOC606724 2682 ITGAL 2683 SRCAP//SNORA30 2684
ZNF646//ZNF668 2685 C16orf67 2686 TMEM188 2687 LPCAT2 2688 CETP
2689 CKLF 2690 CMTM1//CKLF 2691 TMEM208 2692 CTCF 2693 THAP11 2694
NUTF2 2695 EDC4 2696 SLC7A6//SLC7A6OS 2697 PRMT7 2698 SNTB2 2699
VPS4A 2700 DDX19B//DDX19A 2701 CHST4 2702 HP//HPR 2703 PLCG2 2704
KLHL36 2705 KIAA0182 2706 BANP//RUNDC2C 2707 TRAPPC2L 2708 SPG7
2709 CDK10 2710 TCF25 2711 AFG3L1 2712 LUC7L 2713 AXIN1 2714 JMJD8
2715 LMF1 2716 UNKL 2717 UNKL 2718 CLCN7 2719 MRPS34 2720 RNPS1
2721 NLRC3 2722 TRAP1//DNASE1 2723 ADCY9 2724 CORO7 2725 C16orf72
2726 RRN3//LOC653390// 2727 LOC730092//LOC100131998
XYLT1//LYRM2//ZC3H11A 2728 DCUN1D3//LYRM1 2729 IGSF6//METTL9 2730
CDR2//RRN3// 2731 LOC100131998//LOC653390 COG7 2732 GGA2 2733
NSMCE1 2734 GTF3C1 2735 CCDC101//LOC388242 2736 C16orf54 2737
KCTD13 2738 SEPT1 2739 ZNF764//ZNF747 2740 C16orf58//LOC100128371
2741 ITFG1 2742 ABCC11//LONP2 2743 NUDT21 2744 BBS2//OGFOD1 2745
CSNK2A2 2746 GOT2 2747 FAM96B 2748 FHOD1//SLC9A5 2749
ATP6V0D1//LOC100132855 2750 GFOD2 2751 SLC12A4 2752 DPEP3 2753
DPEP2 2754 CHTF8//HAS3 2755 COG8//PDF 2756 TERF2 2757 AARS 2758
ST3GAL2 2759 VAC14//LOC100130894 2760 AP1G1 2761 WDR59 2762
CTRB2//CTRB1 2763 TAF1C//ADAD2 2764 FBXO31 2765 ZCCHC14 2766 FAM38A
2767 CENPBD1 2768 TIMM22 2769 RPA1 2770 DPH1//OVCA2 2771 SGSM2 2772
ARRB2 2773 LOC100130950 2774 DNAH2 2775 PIGL 2776 TRPV2 2777 MPRIP
2778 DRG2 2779 ALKBH5//FLJ13773 2780 SMCR7 2781 WSB1 2782 TAOK1
2783 CPD 2784 SUZ12P 2785 RNF135 2786 ZNF830 2787 TAF15 2788 GGNBP2
2789 LASP1 2790 PSMD3 2791 CDC6 2792 NBR2 2793 TMUB2 2794
MGC57346//C17orf69 2795 NSF//LOC728806 2796 GOSR2 2797
NPEPPS//TBC1D3F//LOC440434 2798 KPNB1 2799 CDK5RAP3 2800 ATP5G1
2801 UBE2Z 2802 XYLT2//LOC100130580 2803 NOG 2804 DGKE 2805 AKAP1
2806 TMEM49//CLTC//MIR21 2807 CLTC 2808 CA4 2809 C17orf64 2810
DCAF7 2811 PITPNC1 2812 NOL11//SNORA38B 2813 MAP2K6 2814 COG1 2815
CD300A 2816 TMEM104 2817 MRPS7 2818 KIAA0195 2819 TSEN54 2820 LLGL2
2821 LOC100134934//CDK3 2822 MFSD11 2823 SEPT9 2824 TNRC6C 2825
TMC8 2826 ENGASE 2827 RPTOR 2828 GPS1 2829 FN3KRP 2830 TBCD 2831
GEMIN4 2832 GLOD4 2833 SLC43A2 2834 PRPF8 2835 SMG6//C17orf6 2836
METT10D//LOC284009 2837 SHPK 2838 TAX1BP3 2839 P2RX5 2840
MYBBP1A//SPNS2 2841 PELP1 2842 PFN1 2843 ZNF232 2844 DHX33 2845
DERL2 2846 NLRP1//LOC728392 2847 ASGR2 2848 NEURL4//GPS2//D4S234E
2849 ZBTB4 2850 TP53 2851 VAMP2 2852 PIK3R5 2853 ELAC2 2854
NCOR1//C20orf191// 2855 LOC100131704 ZNF287 2856 TOM1L2//LOC246315
2857 GRAP//SNORD3B-1// 2858 SNORD3B-2//LOC400581 ALDOC 2859 SDF2
2860 RAB34 2861 PHF12 2862 NUFIP2 2863 OMG 2864 EVI2B 2865
C17orf66//RSL24D1 2866 SYNRG//LOC100131822 2867 PLXDC1 2868 CACNB1
2869
PGAP3 2870 MED24 2871 NR1D1//THRA 2872 CCR7 2873 STAT5B//STAT5A
2874 FAM134C 2875 VAT1 2876 DUSP3 2877 C17orf65//ASB16 2878 UBTF
2879 GPATCH8 2880 MAP3K14//LOC100133991 2881 OSBPL7 2882 SLC35B1
2883 TOB1 2884 COX11//TOM1L1 2885 VEZF1 2886 SFRS1//FLJ44342 2887
SEPT4 2888 MED13//LOC100129112 2889 LIMD2//MAP3K3 2890 STRADA 2891
FTSJ3 2892 CD79B 2893 ICAM2 2894 ERN1 2895 TEX2 2896
LRRC37A3//LRRC37A2// 2897 LRRC37A//ARL17P1//
LRRC37A4//LOC100294335// LOC644397 GNA13 2898 WIPI1//ARSG 2899
FAM20A 2900 NAT9 2901 GGA3 2902 H3F3B//H3F3C 2903 EXOC7 2904 SFRS2
2905 TMC6//LOC100131096 2906 USP36 2907 CD7 2908 RAB31 2909 VAPA
2910 SEH1L 2911 HQ0644/PRO0644 2912 RNMT 2913 RNF138 2914 GALNT1
2915 ELP2 2916 PIK3C3 2917 SLC14A2 2918 ME2 2919
SERPINB2//SERPINB10 2920 ZNF407 2921 ZNF236 2922
NFATC1//LOC100127994 2923 ENOSF1//TYMS 2924 MYOM1 2925 AFG3L2 2926
ABHD3 2927 OSBPL1A 2928 CDH2 2929 DSC1 2930 PSTPIP2 2931 C18orf32
2932 MBD2//SNORA37 2933 PIGN 2934 TMX3 2935 PQLC1 2936 GZMM 2937
ARID3A 2938 CIRBP 2939 DAZAP1 2940 SPPL2B 2941 NFIC 2942 VAV1 2943
ARHGEF18//LOC100128573 2944 STXBP2//LOC554363// 2945 LOC100131801
C19orf59 2946 ZNF317 2947 ILF3 2948 SMARCA4 2949 PRKCSH 2950 IER2
2951 CCDC130 2952 DCAF15 2953 IL27RA 2954 KLF2 2955 SIN3B 2956 DDA1
2957 GTPBP3 2958 FAM129C 2959 FCHO1 2960 ARRDC2 2961 IFI30 2962
C19orf60 2963 CRTC1//MAML2 2964 RFXANK//MEF2B//LOC729991 2965
ZNF101 2966 ZNF738 2967 ZNF257//ZNF492//ZNF99// 2968
ZNF98//LOC646864 C19orf2 2969 KIAA0355//FLJ21369 2970 USF2 2971
TMEM147 2972 LIN37//PSENEN 2973 C19orf55 2974 TBCB//POLR2I 2975
ZNF382 2976 ZNF568 2977 ZNF420 2978 ZNF383 2979 CCDC97 2980 ZNF574
2981 CD177 2982 ZNF230//ZNF222 2983 VASP 2984 GRWD1 2985 FLT3LG
2986 ZNF175 2987 NCRNA00085 PPP2R1A ZNF808//ZNF578//ZNF611 2988
LENG8 2989 FCAR 2990 RPL28 2991 U2AF2 2992 LOC100288114//MGC9913
ZFP28 2993 ZNF460 2994 ZNF549 2995 ZNF211 2996 ZNF587//ZNF417 2997
ZNF274 2998 ZNF544 2999 ZNF8 3000 TRIM28 3001 C19orf6 3002 C19orf34
3003 GNG7 3004 AES 3005 EEF2//SNORD37 3006 PLIN5//LRG1 3007 PLIN3
3008 PTPRS 3009 SAFB2//SAFB 3010 RANBP3 3011 GTF2F1//LOC100130856
3012 XAB2 3013 ELAVL1 3014 ADAMTS10 3015 FBXL12 3016 DNMT1 3017
TYK2 3018 KEAP1 3019 KRI1 3020 TMEM205//hCG_29977 3021 ZNF563 3022
MAN2B1//MORG1 3023 C19orf56 3024 DHPS 3025 TNPO2//SNORD41 3026
LPHN1 3027 NDUFB7 3028 AKAP8 3029 AKAP8L 3030
CHERP//C19orf44//CALR3 3031 INSL3//JAK3 3032 IL12RB1 3033 UPK1A
3034 TYROBP 3035 ZNF529 3036 ZNF461 3037 ZNF607 3038 YIF1B 3039
PRR13 3040 CEACAM4 3041 PLAUR 3042 TRAPPC6A 3043 ERCC1//CD3EAP 3044
RTN2 3045 SYMPK 3046 PGLYRP1 3047 NOSIP 3048 PNKP 3049 NKG7 3050
FPR1 3051 ZNF28 3052 OSCAR 3053 MBOAT7 3054 LILRA5 3055 LILRA4 3056
ZNF550//ZNF549 3057 ZNF416 3058 ZNF256 3059 ZNF329 3060 FAM110A
3061 ITPA 3062 CDC25B 3063 CDS2 3064 CRLS1 3065 CSRP2BP 3066 SEC23B
3067 SLC24A3 3068 HCK 3069 ASXL1 3070 ACSS2 3071 C20orf4 3072 TGIF2
3073 C20orf24//SLA2 3074 RPN2//EEF1A2 3075 CTNNBL1 3076 ACTR5 3077
PPP1R16B 3078 DHX35 3079 PLCG1 3080 MYBL2 3081
SYS1//SYS1-DBNDD2//DBNDD2 3082 DNTTIP1 3083 CTSA 3084
MMP9//LOC100128028 3085 DDX27 3086 SLC9A8 3087 RNF114 3088 PTPN1
3089 TSHZ2 3090 PFDN4 3091 CSTF1 3092 CASS4 3093 GNAS 3094
C20orf177 3095 CDH26 3096 C20orf197 3097 LOC284757 ARFGAP1 3098
PRPF6 3099 NSFL1C 3100 SIRPD 3101 SIRPG//SIRPA 3102 RNF24 3103
RASSF2 3104 TMX4 3105 JAG1 3106 C20orf74 3107 C20orf3 3108
C20orf112 3109 CDK5RAP1 3110 AHCY 3111
GGT7 3112 EDEM2 3113 RBM39//LOC643167 3114 BLCAP 3115
SERINC3//TTPAL 3116 ZNF335 3117 ELMO2 3118 B4GALT5 3119 DPM1 3120
ZFP64 3121 ZNF217 3122 CTSZ 3123 SYCP2 3124 PSMA7 3125 DIDO1 3126
YTHDF1 3127 CHODL 3128 BACH1 3129 C21orf41//BACH1 3130 IL10RB 3131
IFNAR1 3132 IFNGR2 3133 SON 3134 MORC3//DOPEY2 3135 DYRK1A 3136
KCNJ15 3137 ETS2 3138 RRP1B 3139 PFKL 3140 TRPM2 3141 ADARB1 3142
SAMSN1//LOC388813 3143 N6AMT1 3144 SYNJ1 3145 TMEM50B 3146 KCNE1
3147 PRDM15 3148 C2CD2 3149 WDR4 3150 U2AF1 3151 CSTB 3152
UBE2G2//SUMO3 3153 PTTG1IP 3154 POFUT2 3155 MCM3AP 3156
IL17RA//CECR7 3157 C22orf37 3158 LZTR1 3159 PPIL2//YPEL1 3160 CYTSA
3161 SNRPD3//C22orf13 3162 NF2 3163 LIMK2 3164 SLC5A1 3165 MCM5
3166 NCF4 3167 GGA1 3168 SH3BP1//PDXP 3169 POLR2F//LOC100131530
3170 APOBEC3A//APOBEC3B 3171 APOBEC3D 3172 ATF4 3173 CACNA1I 3174
ZC3H7B 3175 CCDC134 3176 TSPO 3177 NUP50 3178
TBC1D22A//LOC100289878 3179 RP3-402G11.5 3180 SAPS2 3181 NCAPH2
3182 BID 3183 SLC25A1 3184 KLHL22//KRT18 3185 PI4KA//PI4KAP1// 3186
PI4KAP2//LOC100293141 MAPK1 3187 ZNF70 3188 TPST2 3189
SF3A1//CCDC157 3190 PES1 3191 PIK3IP1 3192 PATZ1 3193 C22orf30 3194
IL2RB 3195 CSNK1E//LOC400927 3196 UNC84B 3197 CBX7//LOC100128400
3198 RPS19BP1 3199 MKL1//KIAA1659 3200 RANGAP1 3201 TCF20 3202
LDOC1L 3203 UNQ6126 3204 TUBGCP6 3205 SBF1//SBF1P1 3206 MSL3 3207
MOSPD2 3208 BMX//HNRPDL 3209 PDHA1 3210 YY2 3211 PDK3 3212
GK//GK3P//FTL//LOC652904 3213 CXorf59 3214 ATP6AP2 3215
USP9X//USP9Y 3216 RP2 3217 USP11 3218 RBM3 3219 FTSJ1 3220 WAS 3221
PLP2 3222 TSPYL2//GPR173 3223 MAGED2 3224 UBQLN2 3225 NLGN3 3226
ACRC 3227 UPRT 3228 CXorf26 3229 ATP7A 3230 DIAPH2 3231
CSTF2//RAD21 3232 ARMCX3 3233 ARMCX5 3234 GPRASP1 3235 TMEM31 3236
TBC1D8B 3237 MID2 3238 DOCK11 3239 LONRF3 3240 UBE2A 3241 SH2D1A
3242 OCRL 3243 SLC25A14 3244 HPRT1 3245 CD40LG 3246 AFF2 3247
SSR4//IDH3G 3248 FAM50A 3249 DKC1//SNORA36A//SNORA56 3250 ARSD 3251
KAL1 3252 CTPS2 3253 RPS6KA3 3254 BCOR 3255 MAOB//NAT13 3256 ZNF41
3257 OTUD5 3258 KCND1 3259 ZMYM3 3260 MAGT1 3261 BRWD3 3262 TRMT2B
3263 GLA 3264 MORF4L2 3265 PSMD10 3266 ACSL4 3267 LAMP2 3268 CUL4B
3269 ODZ1 3270 ELF4 3271 RAP2C 3272 FAM127B//FAM127C//FAM127A 3273
TMEM185A 3274 ARD1A 3275 IRAK1 3276 DNASE1L1//RPL10 3277 SH3KBP1
3278 Mitochondrial N/A Mitochondrial N/A CCNL2 3279 INPP5B 3280
TLR5 3281 ADRB3//GOT1L1 3282 NOC2L//SAMD11// 3283 LOC401010 SHFM1
3284 .sup..sctn. HUGO Gene Nomenclature Committee .sup. Synonymous
with
SPNS1//NPIPL2//LOC728741//LOC730153//NPIPL3//SPIN1//LOC728888//LOC1002891-
69//LOC728734//LOC729602//LOC100288442//LOC100288332 * Synonymous
with
SNURF//IPW//SNORD116-16//SNORD116-18//SNORD116-21//SNORD116-22//SNORD116--
17//SNORD116-19//PAR5//PAR-SN//SNORD116-2//SNORD116-25//SNORD116-26//SNORD-
107//SNORD115-12//SNORD115-5//SNORD115-6//SNORD115-9//SNORD116-11//SNORD11-
6-12//SNORD116-13//SNORD116-28//SNORD116-4//SNORD64//PAR1//SNORD109A//SNOR-
D109B//SNORD116-6//SNORD116-3//SNORD116-9//SNORD115-13//SNORD115-1//SNORD1-
15-14//SNORD115-15//SNORD115-21//SNORD115-10//SNORD115-7//SNORD115-16//SNO-
RD115-40//SNORD115-42//SNORD115-11//SNORD115-29//SNORD115-34//SNORD115-36/-
/SNORD115-4//SNORD115-43//HBII-52-24//SNORD116-5//SNORD116-7//SNORD115-26/-
/SNORD115-30//SNORD116-15//SNORD116-8//SNORD115-2//SNORD115-39//SNORD116-1-
4//SNORD116-20//SNORD115-8//SNORD115-3//SNORD115-38//SNORD115-41//SNORD115-
-22//SNORD115-44//SNORD116-1//SNORD115-17//SNORD115-18//SNORD115-19//SNORD-
115-20//SNORD116@
Sequence CWU 0 SQTB SEQUENCE LISTING The patent application
contains a lengthy "Sequence Listing" section. A copy of the
"Sequence Listing" is available in electronic form from the USPTO
web site
(http://seqdata.uspto.gov/?pageRequest=docDetail&DocID=US20150218640A1).
An electronic copy of the "Sequence Listing" will also be available
from the USPTO upon request and payment of the fee set forth in 37
CFR 1.19(b)(3).
0 SQTB SEQUENCE LISTING The patent application contains a lengthy
"Sequence Listing" section. A copy of the "Sequence Listing" is
available in electronic form from the USPTO web site
(http://seqdata.uspto.gov/?pageRequest=docDetail&DocID=US20150218640A1).
An electronic copy of the "Sequence Listing" will also be available
from the USPTO upon request and payment of the fee set forth in 37
CFR 1.19(b)(3).
* * * * *
References