CN110832327A - 诊断性晚期糖基化终末产物抗体 - Google Patents
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Abstract
一种诊断与患者中的细胞衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:从患者获得样本;测量样本中的显示出细胞表面AGE的细胞的数量;以及当样本中的显示出细胞表面AGE的细胞的数量大于对照中的显示出细胞表面AGE的细胞的数量时,诊断患者患有与细胞衰老相关的疾病、紊乱或病理状态。
Description
背景技术
衰老细胞是部分功能的或无功能的并且处于增殖停滞状态的细胞。衰老是细胞的独特状态,并且与生物标志物相关,例如生物标志物p16lnk4a的激活和β-半乳糖苷酶的表达。衰老起始于细胞的损伤或应激(例如生长因子的过度刺激)。
晚期糖基化终末产物(AGEs,也称为经AGE修饰的蛋白或糖基化终末产物)产生于蛋白质侧链与糖的非酶促反应(Ando,K.等,Membrane Proteins of Human ErythrocytesAre Modified by Advanced Glycation End Products during Aging in theCirculation,Biochem Biophys Res Commun.,Vol.258,123,125(1999))。该过程起始于还原糖和氨基基团之间的可逆反应以形成席夫碱,进而形成共价键合的Amadori重排产物。一旦形成,Amadori产物经历进一步重排以生成AGEs。高血糖和氧化应激促进膜蛋白的这一翻译后修饰(Lindsey JB等,“Receptor For Advanced Glycation End-Products(RAGE)andsoluble RAGE(sRAGE):Cardiovascular Implications,”Diabetes Vascular DiseaseResearch,Vol.6(1),7-14,(2009))。AGE也可从其它过程形成。例如,晚期糖基化终末产物Nε-(羧甲基)赖氨酸是脂质过氧化反应和糖氧化反应两者的产物。AGEs与多种病理状态相关,该病理状态包括炎症、视网膜病、肾病、动脉粥样硬化、中风、内皮细胞功能障碍和神经退行性紊乱(Bierhaus A,“AGEs and their interaction with AGE-receptors invascular disease and diabetes mellitus.I.The AGE concept,”Cardiovasc Res,Vol.37(3),586-600(1998))。
经AGE修饰的蛋白也是衰老细胞的标志物。糖基化终末产物与衰老之间的这种关联是本领域公知的。参见例如Gruber,L.(WO 2009/143411,26Nov.2009),Ando,K.等(Membrane Proteins of Human Erythrocytes Are Modified by Advanced GlycationEnd Products during Aging in the Circulation,Biochem Biophys Res Commun.,Vol.258,123,125(1999)),Ahmed,E.K.等(“Protein Modification and ReplicativeSenescence of Wl-38Human Embryonic Fibroblasts”Aging Cells,vol.9,252,260(2010)),Vlassara,H.等(Advanced Glycosylation Endproducts on Erythrocyte CellSurface Induce Receptor-Mediated Phagocytosis by Macrophages,J.Exp.Med.,Vol.166,539,545(1987))和Vlassara等(“High-affinity-receptor-mediated Uptakeand Degradation of Glucose-modified Proteins:A Potential Mechanism for theRemoval of Senescent Macromolecules”Proc.Natl.Acad.Sci.USAI,Vol.82,5588,5591(1985))。此外,Ahmed,E.K.等表明糖基化终末产物是“细胞和细胞外蛋白质自发损伤的主要原因之一”(Ahmed,E.K.等,参见上文,第353页)。因此,糖基化终末产物的积累与衰老和功能缺失相关。
引起细胞衰老的损伤或应激也不利地影响细胞中的线粒体DNA以使其产生自由基,所述自由基与细胞中的糖类反应以形成甲基乙二醛(MG)。MG继而与蛋白质或脂质反应以生成晚期糖基化终末产物。在蛋白质成分赖氨酸的情况下,MG反应以形成羧乙基赖氨酸,其为AGE。(Al-Abed,Y.等,“Nε-Carboxymethyllysine formation by direct addition ofglyoxal to lysine during the Maillard reaction”,Bioorganic&MedicinalChemistry Letters,Vol.5,No.18,pp.2161-2162(1995))。
对线粒体DNA的损伤或应激也引发DNA损伤应答,该应答诱导细胞以产生细胞周期阻断蛋白。这些阻断蛋白可阻止细胞分裂。持续的损伤或应激导致mTOR产生,其继而激活蛋白质合成并失活蛋白质分解。进一步刺激细胞导致程序性细胞死亡(细胞凋亡)。
p16是通过抑制S期(合成期)而参与细胞周期调节的蛋白质。它可以在衰老过程中或响应于各种应激(例如DNA损伤、氧化应激或暴露至药物)而被激活。p16通常被认为是肿瘤抑制蛋白,导致细胞响应于DNA损伤而衰老,并且不可逆地阻止细胞进入过度增殖状态。然而,在这方面存在一些不明确,因为某些肿瘤显示出p16的过表达,而另外的肿瘤则显示出下调的表达。证据表明某些肿瘤中的p16的过表达由缺陷的视网膜母细胞瘤蛋白(“Rb”)引起。p16作用于Rb以抑制S期,并且Rb下调p16,产生负反馈。缺陷的Rb既不能抑制S期也不能下调p16,从而导致过度增殖细胞中的p16的过表达(Romagosa,C.等,p16Ink4aoverexpression in cancer:a tumor suppressor gene associated with senescenceand high-grade tumors,Oncogene,Vol.30,2087-2097(2011))。
衰老细胞与参与细胞间信号转导的许多因子(包括促炎因子)的分泌有关;这些因子的分泌已被称为衰老相关的分泌表型或SASP(Freund,A.,“Inflammatory networksduring cellular senescence:causes and consequences”Trends Mol Med.2010May;16(5):238-46)。自身免疫疾病(例如克罗恩病和类风湿性关节炎)与慢性炎症相关(Ferraccioli,G.等,“Interleukin-1βand Interleukin-6in Arthritis Animal Models:Roles in the Early Phase of Transition from Acute to Chronic Inflammation andRelevance for Human Rheumatoid Arthritis”Mol Med.2010Nov-Dec;16(11-12):552-557)。慢性炎症的特征可能为促炎因子在病理部位附近以高于基线的水平、但低于急性炎症中发现的水平存在。这些因子的实例包括TNF、IL-1α、IL-1β、IL-5、IL-6、IL-8、IL-12、IL-23、CD2、CD3、CD20、CD22、CD52、CD80、CD86、C5补体蛋白、BAFF、APRIL、IgE、α4β1整合素和α4β7整合素。衰老细胞还上调在炎症中起作用的基因,包括IL-1β、IL-8、ICAM1、TNFAP3、ESM1和CCL2(Burton,D.G.A.等,“Microarray analysis of senescent vascular smooth musclecells:a link to atherosclerosis and vascular calcification”,ExperimentalGerontology,Vol.44,No.10,pp.659-665(2009年10月))。由于衰老细胞产生促炎因子,因此仅移除这些细胞产生炎症及促炎因子的量和浓度的大幅降低。
衰老细胞分泌活性氧(“ROS”)作为SASP的部分。ROS被认为在维持细胞衰老中起重要作用。ROS的分泌产生旁观者效应,其中,衰老细胞在邻近细胞中诱导衰老:ROS产生已知激活p16表达的极度细胞损伤,导致衰老(Nelson,G.,A senescent cell bystandereffect:senescence-induced senescence,Aging Cell,Vo.11,345-349(2012))。p16/Rb通路引起ROS的诱导,其继而激活蛋白激酶Cδ生成进一步增强ROS的正反馈回路,有助于维持不可逆的细胞周期停滞;甚至有人提出将癌细胞暴露于ROS可能通过诱导过度增殖细胞中的细胞期停滞来有效治疗癌症(Rayess,H.等,Cellular senescence and tumorsuppressor gene p16,Int J Cancer,Vol.130,1715-1725(2012))。
衰老细胞的相对水平明确地与疾病相关。衰老细胞长期以来与癌症和转移性癌症相关,并且具有10%衰老的成纤维细胞的细胞培养物显示出生长刺激(Krtolica,A.等,“Senescent fibroblasts promote epithelial cell growth and tumorigenesis:alink between cancer and aging”,Proceedings of the National Academy ofSciences,Vol.98,No.21,pp.12072-12077(2001))。作为生物学衰老的测量的有氧适能与更少37%的衰老CD4+T细胞和CD8+T细胞有关(Spielmann,G.等,“Aerobic fitness isassociated with lower proportions of senescent blood T-cells in man”,Brain,Behavior and Immunity,Vol.25,No.8,pp.1521-1529(2011))。同样地,在铁人三项的六个月训练期后两周,铁人三项选手中的衰老的CD4+T细胞增加192%(Cosgrove,C.等,“Theimpact of 6-month training preparation for an Ironman triathlon on theproportions of memory and senescent T cells in resting blood”,EuropeanJournal of Applied Physiology,Vol.112,No.8,pp.2989-2998(2012))。
在衰老细胞的表面表达的晚期糖基化终末产物的增高的水平被认为是各种疾病、紊乱和病理状态的标志物。在纤维肌痛患者的血清和肌肉组织中发现了羧甲基赖氨酸(CML)的增高的水平(Rüster,M.等,“Detection of elevated Nε-carboxymethyllysinelevels in muscular tissue and in serum of patients with fibromyalgia”,Scandinavian Journal of Rheumatology,Vol.34,No.6,pp.460-463(2005))。在糖尿病患者中容易察觉诸如皮肤变薄或褶皱皮肤的加速的皮肤老化(Schmid,D.等,“Collageglycation and skin aging”,Cosmetics and Toiletries Manufacture Worldwide)。类似地,糖尿病患者中的皮肤自体荧光与戊糖素和CML的组织水平相关,且与冠心病和预计死亡率强烈相关(Meerwaldt,R.等,“Skin autofluorescence is a strong predictor ofcardiac mortality in diabetes”,Diabetes Care,Vol.30,No.1,pp.107-112(2007))。因此,升高的AGE水平是与细胞衰老相关的疾病、紊乱和病理状态的公认的标志物。
样本中的AGE的绝对值与疾病明确相关。与对照相比,患有前列腺癌的患者中的血浆CML水平高30μg/mL(Yang,S.等,“Impact of oxidative stress biomarkers andcarboxymethyllysine(an advanced glycation end product)on prostate cancer:aprospective study”,Clinical Genitourinary Cancer,Vol.13,No.5,pp.e347-e351(2015))。
类似地,如WO 2009/143411中所述,衰老细胞与老化或年龄相关紊乱之间的相关性使得年龄相关的标志物成为诊断靶标。端粒长期以来与生物学衰老相关,并且短的端粒长度已被用作年龄有关的疾病(如糖尿病、心血管疾病和癌症)的早发的指标(“TelomereTesting White Paper”,Titanovo)。端粒长度可使用针对DNA样本的聚合酶链式反应(PCR)分析进行测量。利用端粒长度来检测老化和年龄相关紊乱的显著的局限在于并非所有的衰老都涉及端粒。
发明内容
在第一方面,本发明是诊断与患者中的细胞衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:从患者获得样本;测量样本中的显示出细胞表面AGE的细胞的数量;当样本中的显示出细胞表面AGE的细胞的数量大于对照中的显示出细胞表面AGE的细胞的数量时,诊断患者患有与细胞衰老相关的疾病、紊乱或病理状态。
在第二方面,本发明是确定患者的生物学年龄的方法,所述方法包括:从患者获得含有细胞和非细胞物质的样本;将细胞与非细胞物质分离;通过使该细胞与抗AGE抗体接触并检测细胞表面AGE与抗AGE抗体之间的结合来测量样本中的显示出细胞表面AGE的细胞的数量;通过使非细胞物质与抗AGE抗体接触并检测未结合的AGE与抗AGE抗体之间的结合来测量样本中的未结合的AGE的数量;以及比较该样本中的细胞表面AGE与未结合的AGE的比例。
第三方面,本发明是诊断与由患者中的细胞衰老引起的高龄的生物学衰老(advanced biological aging)相关的疾病、紊乱或病理状态的方法,所述方法包括:从患者获得含有细胞和非细胞物质的样本;将细胞与非细胞物质分离;通过使该细胞与抗AGE抗体接触并检测细胞表面AGE与抗AGE抗体之间的结合来测量样本中的显示出细胞表面AGE的细胞的数量;通过使非细胞物质与抗AGE抗体接触并检测未结合的AGE与抗AGE抗体之间的结合来测量样本中的未结合的AGE的数量;比较该样本中的细胞表面AGE与未结合的AGE的比例,以确定患者的生物学年龄;以及当患者的生物学年龄超过患者的实足年龄时,诊断患者患有与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态。
在第四方面,本发明是诊断与由患者中的细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态的方法,该方法包括:从患者获得样本;测量样本中的显示出细胞表面AGE的细胞的数量;通过比较样本中的显示出细胞表面AGE的细胞的数量与年龄匹配的对照中的显示出细胞表面AGE的细胞的数量,确定患者的生物学年龄;以及当患者的生物学年龄大于患者的实足年龄时,诊断患者患有与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态。
在第五方面,本发明是在体内检测受试者中的经AGE修饰的细胞的方法,该方法包括向受试者给予已用可检测标记进行标记的抗AGE抗体。
在第六方面,本发明是用于检测表达细胞表面晚期糖基化终末产物的细胞的试剂盒,所述试剂盒包括:抗AGE抗体,对照样本;以及任选地,与所述抗AGE抗体结合的试剂。
在第七方面,本发明是治疗与患者中的细胞衰老相关的疾病、紊乱或病理状态的方法,所述方法包括向有需要的患者给予治疗有效量的衰老细胞去除剂。患者的生物学年龄超过患者的实足年龄。
定义
术语“肽”意味着由2个-50个氨基酸组成的分子。
术语“蛋白质”意味着由超过50个氨基酸组成的分子。
术语“晚期糖基化终末产物”、“AGE”、“经AGE修饰的蛋白或肽”以及“糖基化终末产物”是指作为如下的结果而形成的经修饰的蛋白或肽:糖与蛋白质侧链反应,进一步重排并形成不可逆的交联。该过程起始于还原糖和氨基基团之间的可逆反应以形成席夫碱,继而形成共价键合的Amadori重排产物。一旦形成,Amadori产物经历进一步的重排以生成AGE。经AGE修饰的蛋白和针对经AGE修饰的蛋白的抗体在Bucala的U.S.5,702,704(“Bucala”)和Al-Abed等的U.S.6,380,165(“Al-Abed等”)中描述。未经历形成AGE的必要的重排的糖化蛋白或肽(例如在糖化白蛋白上发现的N-脱氧果糖基赖氨酸)不是AGE。可以通过存在AGE修饰(也称为AGE表位或AGE部分)来鉴定AGE,所述AGE修饰例如2-(2-呋喃甲酰)-4(5)-(2-呋喃基)-1H-咪唑(“FFI”)、5-羟甲基-1-烷基吡咯-2-甲醛(“吡咯素(Pyrraline)”)、1-烷基-2-甲酰基-3,4-二糖基吡咯(“AFGP”)、非荧光模型AGE、羧甲基赖氨酸、羧乙基赖氨酸、以及戊糖素(pentosidine)。作为另一种AGE的ALI在Al-Abed等中描述。
“抗AGE抗体”或“AGE抗体”意味着结合至经AGE修饰的蛋白或肽并且优选包含抗体的恒定区的抗体、抗体片段或其它蛋白质或肽。所述经AGE修饰的蛋白质或肽可为通常发现结合在细胞表面上的蛋白质或肽,所述细胞优选哺乳动物细胞,更优选人细胞、猫细胞、狗细胞、马细胞、骆驼科动物(例如,骆驼或羊驼)细胞、牛细胞、绵羊细胞或山羊细胞。或者,经AGE修饰的蛋白质或肽可以是不结合至细胞表面的蛋白质或肽(也称为游离的、未结合的或循环的蛋白质或肽)。“抗AGE抗体”或“AGE抗体”不包括以相同的特异性和选择性与经AGE修饰的蛋白质或肽以及相同的非经AGE修饰的蛋白或肽结合的抗体或其它蛋白质,也就是说,AGE修饰的存在不会增加结合。“抗AGE抗体”或“AGE抗体”包括缀合至例如毒素、药物或其它化学品或颗粒的抗体。优选地,抗体是单克隆抗体,但是多克隆抗体也是可以的。
术语“衰老细胞”意味着处于增殖停滞状态并表达衰老的一种或多种生物标志物(例如p16Ink4a的激活或衰老相关的β-半乳糖苷酶的表达)的细胞。还包括表达衰老的一种或多种生物标志物、在体内不增殖但在某些条件下可以在体外增殖的细胞,例如在ALS患者的肌肉中发现的一些卫星细胞。
术语“senolytic试剂”意味着破坏衰老细胞的分子量小于900道尔顿的小分子。术语“senolytic试剂”不包括抗体、抗体缀合物、蛋白质、肽或生物疗法。
术语“衰老细胞去除剂”意味着破坏衰老细胞的物质。衰老细胞去除剂包括治疗性抗AGE抗体(例如U.S.Pat.No.9,161,810中描述的那些治疗性抗AGE抗体)和senolytic试剂。
术语“变体”意味着不同于特异性地识别的序列的核苷酸、蛋白质或氨基酸序列,其中,将一个或多个核苷酸、蛋白质或氨基酸残基进行缺失、置换或添加。变体可以是天然存在的等位基因变体、或非天然存在的变体。经识别的序列的变体可保留经识别的序列的一些或全部功能特征。
术语“序列同一性百分比(%)”定义为,在对序列进行比对并引入空位(如果需要的话,以实现最大的序列同一性百分比)之后,候选序列中的与参考多肽序列中的氨基酸残基相同的氨基酸残基的百分比,并且不考虑将任何保守置换作为序列同一性的一部分。可使用公众可得的计算机软件(例如BLAST、BLAST-2、ALIGN或Megalign(DNASTAR)软件)以多种方式来实现用于确定氨基酸序列同一性的百分比的目的的比对。优选地,使用序列比较计算机程序ALIGN-2产生序列同一性%值。ALIGN-2序列比较计算机程序可从Genentech,Inc.(South San Francisco,CA)公开获得,或者也可从源代码编译而来,该源代码已与用户文档一起提交给美国版权局,并以美国版权注册号TXU510087注册。ALIGN-2程序应被编译以在UNIX操作系统(包括数字化UNIX V4.0D)上使用。所有序列比较参数均由ALIGN-2程序设置,且没有变化。
在利用ALIGN-2进行氨基酸序列比较的情况下,给定氨基酸序列A相对于、同或针对给定氨基酸序列B(或者可以表述为给定氨基酸序列A相对于、同或针对给定氨基酸序列B具有或包含一定的氨基酸序列同一性%)的序列同一性%按如下计算:100乘以分数X/Y,其中X为在A和B的程序ALIGN-2的比对中由序列比对程序ALIGN-2打分为相同匹配的氨基酸残基数,并且其中Y是B中的氨基酸残基的总数。其中氨基酸序列A的长度不等于氨基酸序列B的长度,A与B的氨基酸序列同一性%将不等于B与A的氨基酸序列同一性%。除非另外特别说明,否则本文中使用的所有的氨基酸序列同一性%值都是使用ALIGN-2计算机程序获得的。
附图说明
图1示出了用于检测表达细胞表面晚期糖基化终末产物的细胞的试剂盒。
图2是抗体结合实验中的应答相对于时间的图。
图3A是阿尔茨海默病样本的细胞的照片,显示了羧甲基赖氨酸染成的红色(深灰色)和磷酸化tau染成的绿色(浅灰色)。
图3B是阿尔茨海默病样本的细胞的照片,显示了羧甲基赖氨酸染成的红色(深灰色)和淀粉样前体蛋白染成的绿色(浅灰色)。
图3C是来自黑质的帕金森病样本的细胞的照片,显示了羧甲基赖氨酸染成的红色(深灰色)和α突触核蛋白染成的绿色(浅灰色)。
图3D是来自腹侧被盖区的帕金森病样本的细胞的照片,显示了羧甲基赖氨酸染成的红色(深灰色)和α突触核蛋白染成的绿色(浅灰色)。
具体实施方式
对细胞衰老与各种疾病、紊乱和病理状态之间的可量化关联的认识已使得衰老细胞成为诊断靶标。例如,CD57是衰老细胞的已知标志物,所述衰老细胞包括免疫细胞,例如自然杀伤(NK)细胞和T细胞(Kared,H.等,“CD57 in human natural killer cells and T-lymphocytes”,Cancer Immunology,Immunotherapy,Vol.65,No.4,pp.441-452(2016))。CD57分离试剂盒是可商购的,例如来自Miltenyi Biotec(Bergisch Gladbach,德国)的CD8+CD57+T细胞分离试剂盒,但这些定量测量工具仅用于研究目的。Miltenyi Biotec T细胞分离试剂盒的数据表明确地指出该试剂盒并不用于诊断或治疗用途。
用能够检测蛋白质的分析技术(例如质谱法和高效液相色谱法)进行晚期糖基化终末产物的检测和定量。然而,这些技术很麻烦并且通常依赖于复杂的实验室设备。使用抗AGE抗体测量晚期糖基化终末产物的湿实验室(wet lab)技术(例如免疫测定法)非常易于使用。抗AGE测定法是商业上可得的,例如来自Kamiya Biomedical Company(Seattle,WA,USA)的Cat.No.KT-32428的羧甲基赖氨酸(CML)ELISA。与衰老细胞检测工具非常相似,这些定量测量工具仅旨在用于研究用途。Kamiya Biomedical Company的CML ELISA(Cat.No.KT-32428)的数据表明确指出该产品并不用于诊断程序。因此,将抗AGE抗体用于诊断目的既不是常规的也不是传统的。
本发明使用与经晚期糖基化终末产物修饰的蛋白质和肽结合的抗体来诊断和监测与衰老相关的疾病、紊乱或病理状态。经AGE修饰的蛋白质和肽、特别是部分功能和非功能细胞表面上的经AGE修饰的蛋白和肽是基于抗体的诊断方法(包括酶联免疫吸附测定(ELISA)、细胞分选和细胞计数)的唯一靶标。例如,可将结合细胞的羧甲基赖氨酸(CML)(众所周知的晚期糖基化终末产物)的检测用于确定样本中的衰老细胞的总数、浓度或比例。根据与对照中的显示出细胞表面AGE的细胞的数量相比的样本中的显示出细胞表面AGE的细胞的数量,或者当样本中的显示出细胞表面AGE的细胞的数量超过临床阈值时,可以将患者鉴别为需要治疗。或者或另外地,比较结合细胞的AGE与游离的(未结合的)AGE的比例可以用来将样本中的衰老细胞的数量归一化并监测疾病的进展或生物学衰老。较大比例的结合细胞的AGE表明由内部根源和细胞功能障碍引起的大量的细胞衰老。基于抗AGE抗体的诊断方法提供了微创和易于实施的优势,所述方法允许在医生的办公室或诊所进行此类测试。
抗AGE抗体可用于检测样本中的衰老细胞的存在,因为衰老细胞表达细胞表面晚期糖基化终末产物。在一个实施方式中,提供了样本。样本可从人类患者获取。接下来,通过使样本与抗AGE抗体接触并检测细胞表面AGE与抗AGE抗体之间的结合来确定或测量样本中的细胞表面AGE的存在。任选地,可从患者或健康受试者获得对照样本作为比较的基线。还可以从一组健康对照获得用于比较的基线,作为显示出AGE修饰的细胞的平均数。优选地,对照样本从与患者(从该患者获得样本)具有相同的实足年龄的健康受试者(也称为“年龄匹配的”对照或“年龄索引的”对照)获得。
可以使用定性或定量测量确定显示出细胞表面AGE的细胞的数量。该测量旨在提供可用于与健康对照进行比较的信息。定量测量的实例包括测量样本中的显示出细胞表面AGE的细胞的总数、平均数、浓度、比例或百分比。定性测量的实例包括用免疫组织化学技术或免疫细胞化学技术分析组织样本。例如,样本中的糖基化的位置可指示与细胞衰老相关的疾病、紊乱或病理状态。
样本中的衰老细胞的测量可用于诊断患有与细胞衰老相关的疾病、紊乱或病理状态的患者,或用于鉴别患者是否需要治疗。当样本中的显示出细胞表面AGE的细胞的总数、平均数、浓度、比例或百分比超过对照中的显示出细胞表面AGE的细胞的总数、平均数、浓度、比例或百分比时,可表明细胞功能障碍的升高的水平。例如,含有大于5%衰老细胞的样本表明细胞功能障碍的升高的水平。在表现出症状或接受健康护理专业人员的临床诊断之前,可将患者诊断为患有与细胞衰老相关的疾病、紊乱或病理状态,或将其辨别为需要治疗。优选地,在测试之前,患者已经表现出与细胞衰老相关的疾病、紊乱或病理状态的至少一种症状,以帮助鉴定与细胞衰老相关的疾病、紊乱或病理状态。样本中的衰老细胞的测量还可用于鉴别诊断,以区分具有重叠或相似症状的疾病、紊乱或病理状态。
当样本中的表现出细胞表面AGE的细胞的数量超过临床阈值时,也可显示出细胞功能障碍的升高的水平。例如,如果样本含有5%-50%的衰老细胞,包括至少6%、7%、8%、9%、10%、11%、12%、13%、14%、15%、16%、17%、18%、19%、20%、21%、22%、23%、24%、25%、30%、35%、40%和45%的衰老细胞,可诊断患者患有与细胞衰老相关的疾病、紊乱或病理状态,或者将其鉴别为需要治疗。临床阈值可基于从健康患者获得的样本的集合中发现的经AGE修饰的细胞的最高数目或平均数目。
样本中的衰老细胞的测量也可用于确定患者的生物学年龄。由于衰老细胞随年龄而积累,因此与年龄匹配的对照相比,样本中的更多数量的衰老细胞表明高龄的生物学年龄(advanced biological age)。当患者的生物学年龄大于患者的实足年龄时,可将患者辨别为需要治疗。例如,当她的生物学年龄比她的实足年龄大10%-50%时,包括比她的实足年龄大至少15%、20%、25%、30%、35%、40%和45%时,可将患者诊断为具有年老的生物学年龄。类似地,当她的生物学年龄比她的实足年龄大5岁-50岁时,包括比她的实足年龄大至少10岁、15岁、20岁、25岁、30岁、35岁、40岁和45岁时,可将患者诊断为具有高龄的生物学年龄。
还可将抗AGE抗体用于检测样本中的游离的(未结合的)AGE和经AGE修饰的蛋白质或肽。游离的AGE可充当与细胞衰老无关的晚期糖基化终末产物的度量。可将样本中的细胞表面AGE的数量与游离的AGE的数量进行比较,以将样本中的衰老细胞的数量归一化。例如,可将细胞表面AGE与游离的AGE的比例用于确定已累积在细胞表面上的AGE百分比,具有高的比例表明细胞衰老的增长。还可将样本中的衰老细胞的百分比用作患者的生物学年龄的度量。
样本可为从包含可能是衰老的细胞的患者获得的任何物质。合适的样本的实例包括唾液、颊拭子、血样、尿样、皮肤样本和活检样本。可任选地对样本进行物理处理(例如通过离心)、或化学处理(例如通过胰蛋白酶消化)。样本处理可用于分离样本的特定部分,例如将血样分离为血清和血浆。
就细胞表面的晚期糖基化终末产物的存在进行测试的样本中的细胞可以是能够经历细胞衰老的任何细胞。待测试的合适的细胞的实例包括T细胞、红细胞、成纤维细胞和上皮细胞。T细胞是用于测试的优选细胞。
可通过任何基于抗体的辨别技术确定样本中的经AGE修饰的肽或蛋白质的存在。合适的抗体辨别技术的实例包括免疫测定(例如酶联免疫吸附测定(ELISA)、放射免疫测定(RIA)和实时免疫定量PCR(iqPCR))、细胞分选(例如荧光激活细胞分选(FACS)、流式细胞术和磁性细胞分选)、细胞计数、蛋白质印迹、免疫组织化学(IHC)、免疫细胞化学(ICC)、免疫沉淀和酶联免疫斑点(ELISPOT)。抗体辨别技术优选为免疫测定。
用于检测组织样本中的衰老细胞的优选技术是免疫组织化学(IHC)染色。组织样本的组织学分析是用于辨别组织样本中的特定蛋白质的成熟技术。例如,已在动脉粥样硬化病变和胰腺癌的组织样本中检测到AGE(Wendel,U.等,“A novel monoclonal antibodytargeting carboxymethyllysine,an advanced glycation end product inatherosclerosis and pancreatic cancer”,PLoS One,Vol.13,No.2,e0191872(2018))。免疫组织化学染色使得能够检测糖基化的特定位点。
诊断技术可在获得样本的现场进行。或者,可将样本寄送到异地测试机构,例如实验室。
抗AGE抗体可以是与经AGE修饰的蛋白质或肽(包括在衰老细胞表面上表达的经AGE修饰的蛋白质或肽)结合的任何抗体。抗AGE抗体是本领域已知的并且可商购。实例包括在U.S.5,702,704(Bucala)和U.S.6,380,165(Al-Abed等)中描述的那些。该抗体可结合至一种或多种具有AGE修饰的经AGE修饰的蛋白质或肽,所述AGE修饰例如FFI、吡咯素、AFGP、ALI、羧甲基赖氨酸(CML)、羧乙基赖氨酸(CEL)和戊糖素,以及此类抗体的混合物。该抗体可为单克隆的或多克隆的。该抗体优选为单克隆抗体。
优选的抗AGE抗体包括与显示出羧甲基赖氨酸或羧乙基赖氨酸AGE修饰的蛋白质或肽结合的抗体。作为氧化应激和化学糖基化作用的结果,羧甲基赖氨酸(也称为N(ε)-(羧甲基)赖氨酸、N(6)-羧甲基赖氨酸或2-氨基-6-(羧甲基氨基)己酸)和羧乙基赖氨酸(也称为N-ε-(羧乙基)赖氨酸)在蛋白质、肽和脂质上被发现。经CML修饰和经CEL修饰的蛋白质或肽被在各种细胞上表达的受体RAGE识别。已经对CML和CEL进行了深入研究,并且与CML和CEL相关的产品可商购。例如,Cell Biolabs,Inc.销售CML-BSA抗原、CML多克隆抗体、CML免疫印迹试剂盒和CML竞争性ELISA试剂盒(www.cellbiolabs.com/cml-assays)以及CEL-BSA抗原和CEL竞争性ELISA试剂盒(www.cellbiolabs.com/cel-n-epsilon-carboxyethyl-lysine-assays-and-reage nts)。优选的可商购的抗AGE抗体是针对与钥孔血蓝蛋白缀合的羧甲基赖氨酸产生的小鼠抗糖基化终末产物抗体(克隆318003),其可从R&D Systems,Inc.(Minneapolis,MN;目录号MAB3247)获得。
抗AGE抗体可具有或可包括具有SEQ ID NO:1的蛋白质序列的重链和具有SEQ IDNO:3的蛋白质序列的轻链。重链和轻链的可变区分别以SEQ ID NO:2和SEQ ID NO:4示出。额外的抗AGE抗体的DNA序列和蛋白质序列可见于WO 2017/143073(国际专利申请号PCT/US2017/18185的公开文本),将其通过引用并入本文。
抗AGE抗体可任选地为双特异性抗体,所述双特异性抗体是针对两个不同表位的抗体。此类抗体含有来自一种抗AGE抗体的可变区(或互补决定区)和来自不同抗体的可变区(或互补决定区)。
可使用抗体片段代替完整抗体。例如,可通过用酶消化将免疫球蛋白G分解成较小的片段。木瓜蛋白酶消化切割重链间二硫键的N末端侧以产生Fab片段。Fab片段包含轻链以及重链(也称为Fd片段)的两个N末端结构域之一。胃蛋白酶消化切割重链间二硫键的C末端侧以产生F(ab’)2片段。F(ab’)2片段包含轻链以及通过二硫键连接的两个N末端结构域。胃蛋白酶消化还可形成Fv(可变片段)片段和Fc(可结晶片段)片段。Fv片段包含两个N末端可变结构域。Fc片段包含与细胞上的免疫球蛋白受体以及补体级联的起始元件相互作用的结构域。胃蛋白酶还可在重链的第三个恒定结构域(CH3)之前切割免疫球蛋白G,以产生大片段F(abc)和小片段pFc'。抗体片段也可重组产生。
可使用公知的方法制造抗体。例如,多克隆抗体(pAb)可通过一次或多次注射免疫原(并且如果期望的话,注射佐剂)在哺乳动物宿主中产生。通常,通过皮下或腹膜内注射将免疫原(和佐剂)注射到哺乳动物中。免疫原可以是细胞的经AGE修饰的蛋白或肽,例如AGE-抗凝血酶III、AGE-钙调蛋白、AGE-胰岛素、AGE-血浆铜蓝蛋白、AGE-胶原蛋白、AGE-组织蛋白酶B、AGE-白蛋白(例如AGE-牛血清白蛋白(AGE-BSA)、AGE-人血清白蛋白和卵白蛋白)、AGE-晶状体蛋白、AGE-纤溶酶原激活物、AGE-内皮膜蛋白、AGE-醛还原酶、AGE-转铁蛋白、AGE-纤维蛋白、AGE-铜/锌SOD、AGE-载脂蛋白B、AGE-纤连蛋白、AGE-胰腺核糖、AGE-载脂蛋白A-I和载脂蛋白A-II、AGE-血红蛋白、AGE-Na+/K+-ATP酶、AGE-血浆酶原、AGE-髓磷脂、AGE-溶菌酶、AGE-免疫球蛋白、AGE-红细胞谷氨酸转运蛋白、AGE-β-N-乙酰基己糖胺酶、AGE-载脂蛋白E、AGE-红细胞膜蛋白、AGE-醛糖还原酶、AGE-铁蛋白、AGE-红细胞血影蛋白、AGE-乙醇脱氢酶、AGE-触珠蛋白、AGE-微管蛋白、AGE-甲状腺激素、AGE-纤维蛋白原、AGE-β2-微球蛋白、AGE-山梨醇脱氢酶、AGE-α1-抗胰蛋白酶、AGE-碳酸盐脱水酶、AGE-核糖核酸酶、AGE-低密度脂蛋白、AGE-己糖激酶、AGE-载脂蛋白C-1、AGE-核糖核酸酶、AGE-血红蛋白(例如AGE-人血红蛋白)、AGE-低密度脂蛋白(AGE-LDL)和AGE-胶原蛋白IV。还可将完整的、裂解的或部分消化的经AGE修饰的细胞(例如经AGE修饰的红细胞)用作AGE抗原。佐剂的实例包括弗氏完全的、单磷酰脂A合成海藻糖dicorynomycolate、氢氧化铝(alum)、热休克蛋白HSP70或HSP96、含有单磷酰脂A的角鲨烯乳液、α2-巨球蛋白和表面活性物质(包括油乳剂、pluronic多元醇、聚阴离子和二硝基苯酚)。为了改善免疫应答,可将免疫原与宿主中具有免疫原性的多肽(例如钥孔血蓝蛋白(KLH)、血清白蛋白、牛甲状腺球蛋白、霍乱毒素、不稳定肠毒素、二氧化硅颗粒或大豆胰蛋白酶抑制剂)进行缀合。优选的免疫原缀合物为AGE-KLH。或者,可在鸡中制备pAb,产生IgY分子。
单克隆抗体(mAbs)也可以通过如下制造:对宿主或来自宿主的淋巴细胞进行免疫,收集分泌(或潜在分泌)mAb的淋巴细胞,将这些淋巴细胞融合至永生化细胞(例如骨髓瘤细胞),以及选择分泌期望的mAb的那些细胞。也可以使用其它技术,例如EBV杂交瘤技术。如果期望的话,mAb可通过常规方法(例如蛋白A-琼脂糖、羟基磷灰石层析、凝胶电泳、透析、硫酸铵沉淀或亲和层析)从培养基或腹水中纯化。
可将抗AGE抗体用来诊断以细胞衰老为特征的任何疾病、紊乱或病理状态的起始,或测量以细胞衰老为特征的任何疾病、紊乱或病理状态的进展。与细胞衰老相关的疾病、紊乱和病理状态的实例包括阿尔茨海默病、肌萎缩侧索硬化症(ALS或Lou Gehrig病)、慢性阻塞性肺病(COPD)、亨廷顿舞蹈病、特发性肺纤维化、肌营养不良症(包括贝克肌营养不良症、杜氏肌营养不良症、肢带型肌营养不良症和山本氏肌营养不良症)、黄斑变性、白内障、糖尿病性视网膜病变、帕金森病、早衰症(包括Werner综合征和Hutchinson Gilford早衰症)、白癜风、囊性纤维化、特应性皮炎、湿疹、关节炎(包括骨关节炎、类风湿性关节炎和幼年型风湿性关节炎)、动脉粥样硬化、癌症和转移性癌症(包括例如,乳腺癌、三阴性乳腺癌、肺癌、黑色素瘤、结肠癌、肾细胞癌、前列腺癌、宫颈癌、膀胱癌、直肠癌、食管癌、肝癌、口腔和喉癌、多发性骨髓瘤、卵巢癌、胃癌、胰腺癌和视网膜母细胞瘤癌)、癌症治疗相关的失能或癌症治疗副作用、高血压、青光眼、骨质疏松症、肌肉减少症、恶病质、中风、心肌梗塞、心房纤颤、移植排斥、I型糖尿病、II型糖尿病、辐射暴露、HIV治疗副作用、化学武器暴露、中毒、炎症、肾病、路易体痴呆、朊病毒病(包括牛海绵状脑病、克雅病、瘙痒病、慢性消耗性疾病、库鲁病和致命性家族性失眠症)、驼背病、自身免疫紊乱、脂肪组织缺损、牛皮癣、克罗恩病、哮喘、衰老的生理影响(包括“美容”作用,如皱纹、老年斑、脱发;皮下脂肪组织缺损和皮肤变薄)、特发性肌病(包括例如特发性炎性肌病、特发性炎性肌炎、多发性肌炎、皮肌炎、散发性包涵体肌炎和幼年型肌炎)、多发性硬化症、视神经脊髓炎(NMO、德维克氏病或德维克氏综合征)、癫痫和肾上腺白质营养不良(ALD、X连锁肾上腺白质营养不良、X-ALD、脑ALD或cALD)。
可通过本文所述的方法诊断可发展出与细胞衰老相关的疾病、紊乱或病理状态的任何受试者。受试者可以是哺乳动物。人类是用于诊断的优选的受试者。可被诊断的其它受试者包括小鼠、大鼠、山羊、绵羊、牛、马、骆驼和伴侣动物(例如狗或猫)。
可对已被诊断为患有与细胞衰老相关的疾病、紊乱或病理状态或者被鉴别为需要治疗的患者给予衰老细胞去除剂来靶向和破坏衰老细胞。衰老细胞去除剂的实例包括治疗性抗AGE抗体、缀合至毒素的抗AGE抗体、senolytic试剂(例如达沙替尼和/或槲皮素)、及其组合。衰老细胞也可通过应用治疗性超声来破坏。可将衰老细胞毁坏技术进行联合来实现期望的治疗结果。例如,可对患者给予达沙替尼和槲皮素的组合以及高强度聚焦超声,以选择性破坏衰老细胞且同时放过功能细胞。衰老细胞去除剂的治疗有效量将根据所使用的具体的衰老细胞去除剂而变化。例如,抗AGE抗体的合适的剂量水平通常为约0.01mg/kg患者体重至500mg/kg患者体重,包括约0.01mg/kg至250mg/kg、约0.05mg/kg至100mg/kg和约0.1mg/kg至50mg/kg。类似地,联合治疗达沙替尼和槲皮素的合适的剂量水平通常为约5mg/kg患者体重的达沙替尼和约50mg/kg患者体重的槲皮素。可通过重复测量显示出细胞表面AGE的细胞的数量来监测治疗功效。
已经证明,给予衰老细胞去除剂可有效治疗肌肉减少症、动脉粥样硬化和转移性癌症。与细胞衰老相关的其它疾病、紊乱和病理状态特别适合通过给予衰老细胞去除剂进行治疗,包括炎症、自身免疫疾病、骨关节炎、阿尔茨海默病和帕金森病。
除了上述体外诊断方法外,抗AGE抗体也可用于体内诊断方法。体内诊断测试提供了检测经AGE修饰的蛋白质和肽的非侵入方法。体内诊断测试对于检测表达细胞表面晚期糖基化终末产物的衰老细胞(例如转移性癌细胞)特别有用(参见例如,WO 2017/143073)。抗AGE抗体可用可检测的标记或示踪剂进行标记,然后给予受试者。经标记的抗AGE抗体特异性地结合至经AGE修饰的蛋白质或肽,这允许使用能够检测标记的任何合适的装置检测经AGE修饰的蛋白质或肽。体内诊断方法的实例包括正电子发射断层造影术(PET)和免疫PET、磁共振成像(MRI)、单光子发射计算机断层造影术(SPECT)、光学成像、超声、放射性免疫闪烁成像及其组合。可使用适合于给定的诊断技术的任何标记,例如放射性标记、荧光标记、正电子发射体、近红外(NIR)发射的染料、纳米颗粒(例如金和钆)、量子点、超顺磁氧化铁(SPIO)、缀合至抗体的碳纳米管或微泡。
图1示出了用于检测表达细胞表面晚期糖基化终末产物的细胞的试剂盒100。该试剂盒可包括抗AGE抗体110、对照120以及任选地用于检测抗AGE抗体的试剂130。抗AGE抗体、对照和任选试剂可在任何合适的容器(例如瓶、安瓿、封套、试管、小瓶、烧瓶或注射器)中提供。抗AGE抗体和/或试剂可任选地用例如荧光标记、放射性标记或金颗粒进行标记。对照可以是来自在其中制备第二抗体的动物的正常血清、含有已知量的经AGE修饰的蛋白质或肽或者经固定或保存的显示出AGE修饰的细胞的溶液。用于检测抗AGE抗体的试剂的实例包括二抗,例如在驴中制备并用罗丹明标记的抗人多克隆抗体。该试剂盒可任选地被安置在容器140中。该试剂盒可任选地包括印刷说明书150。优选地,该试剂盒的内容物是无菌的并且随时可用。
该试剂盒可任选地包括用于容纳试剂盒成分的容器。该容器可由刚性的耐用材料(例如塑料)制作,或者可以是柔性的,例如袋或软边盒。
该试剂盒可任选地包括使用说明书。说明书可作为印刷说明书或以电子格式(例如在通用串行总线(USB)驱动器上、在安全数字(SD)卡上,或通过互联网托管并可通过快速响应(QR)代码进行访问)提供。
试剂盒可任选地包含额外的诊断材料或设备,例如缓冲液、固定剂、封闭液、蛋白酶抑制剂、用于分析的基底(例如显微镜载玻片和/或盖玻片、微量滴定板)和细胞提取试剂(例如去垢剂和去垢剂溶液)。
实施例
实施例1:颊上皮细胞的收集
患者用在其嘴里的盐溶液漱口30秒钟。然后,她将溶液吐到杯中。然后使用微量移液器将杯中的1.5mL盐溶液转移到离心管中。将离心管放入经平衡的离心机中,并以10000-14000RPM离心2分钟。可以重复离心直到在离心管的底部可见沉淀。然后通过用微量移液器移出和/或移除上清液而将其弃去。沉淀含有分离的颊上皮细胞,然后可对其测试细胞表面AGE的存在,以确定是否有任何上皮细胞衰老。
实施例2:基于皮肤细胞的诊断和治疗
使用胶带收集工艺来采集表皮细胞。将粘性胶带(Adhesives Research,GlenRock,PA)制成直径约17mm圆盘。将该胶带施用至患者的皮肤,然后移除以从角质层收集表皮细胞。胶带收集再重复3次以获得总共4个表皮样本。然后测试表皮细胞是否存在细胞表面AGE,以确定是否有任何表皮细胞衰老。
使用刮取活检来采集真皮细胞。将手术刀片用于去除足够的皮肤以穿过表皮并到达真皮,从而获得样本。然后测试样本中的成纤维细胞是否存在细胞表面AGE,以确定是否有任何成纤维细胞衰老。刮取活检中的至少5%的衰老细胞的存在表明皮肤受损,并且需要治疗以减少衰老的皮肤细胞的数量。给予患者衰老细胞去除剂来靶向和去除衰老的皮肤细胞。
实施例3:使用抗AGE抗体的直接结合ELISA
通过直接结合ELISA研究了鼠源性的和嵌合的抗AGE抗体的结合。将抗羧甲基赖氨酸(CML)抗体(R&D Systems,MAB3247)用作对照。将CML缀合至KLH(CML-KLH),并将CML和CML-KLH两者包被在ELISA板上过夜。将HRP山羊抗小鼠Fc用于检测对照和鼠源性抗AGE抗体。将HRP山羊抗人Fc用于检测嵌合的抗AGE抗体。
在pH 6.5的1×磷酸盐缓冲液中将抗原稀释至1μg/mL。将96孔微量滴定ELISA板用100μL/孔的经稀释的抗原进行包被,并在4℃下放置过夜。将该板用1×PBS、2.5%BSA进行封闭,并使其于第二天早晨在室温下静置1-2小时。抗体样本以50μg/mL的起始浓度用1×PBS、1%BSA连续稀释制备。将二抗以1:5000进行稀释。将100μL抗体稀释液施用至每个孔。将该板在微板振荡器上于室温下孵育0.5-1小时。将板用1×PBS洗涤3次。将100μL/孔的经稀释的HRP-缀合的山羊抗人Fc二抗施加至孔。将板在微板振荡器上孵育1小时。然后将板用1×PBS洗涤3次。将100μL HRP底物TMB添加到每个孔以使板显色。3-5分钟后,通过加入100μL的1N HCl来终止反应。随着仅CML包被,进行第二次直接结合ELISA。使用酶标仪读取在OD450处的吸光度。
CML和CML-KLH ELISA的OD450吸光度原始数据在下面的板图中示出。使用孔板的96个孔中的48个。板图中的空白孔表示未使用的孔。
CML和CML-KLH ELISA的板图:
仅CML ELISA的OD450吸光度原始数据在下面的板图中示出。使用孔板的96个孔中的24个。板图中的空白孔表示未使用的孔。
仅CML ELISA的板图:
对照和嵌合的抗AGE抗体显示出与CML和CML-KLH两者的结合。鼠源性(亲本的)抗AGE抗体显示出非常弱、甚至不与CML或CML-KLH结合。来自重复的ELISA的数据证实对照和嵌合的抗AGE抗体与CML的结合。所有缓冲液对照均显示阴性信号。
该数据证实了抗AGE抗体结合AGE和AGE-免疫原缀合物的能力。与公知的AGE羧甲基赖氨酸结合的证据支持了抗AGE抗体在诊断应用中的适用性。
实施例4:基于血样的诊断和治疗
从患者抽取血样。离心血样以分离血清。使用Miltenyi Biotec CD8+CD57+T细胞分离试剂盒(Bergisch Gladbach,德国)来分离CD57+T细胞。使用血细胞计数器来对CD57+T细胞进行计数。然后测试血清和分离的CD57+T细胞与抗CML抗体的结合。血清CML小于或等于152μg/mL与大于或等于50%的分离的CD57+T细胞结合至标记的抗CML抗体联合起来表明患者需要使用衰老细胞去除剂进行治疗。对患者给予靶向并去除衰老细胞的抗AGE抗体。
实施例5:基于颊拭子的诊断和治疗
通过颊拭子从患者获得样本。分离来自拭子的颊上皮细胞和唾液。将颊细胞用胰蛋白酶消化并与抗CML单克隆抗体混合。然后使混合物通过血细胞计数器以对衰老的颊细胞计数。游离的CML通过唾液的ELISA测量。唾液CML小于或等于3μg/mL与大于或等于50%的颊细胞结合至抗CML抗体联合起来表明患者需要用衰老细胞去除剂进行治疗。对患者给予靶向并去除衰老细胞的缀合至毒素的抗AGE抗体。
实施例6:生物学年龄的确定
通过颊拭子从50岁的患者获得样本。分离来自拭子的颊上皮细胞和唾液。将颊细胞用胰蛋白酶消化并与抗CML单克隆抗体混合。然后使混合物通过血细胞计数器以对衰老的颊细胞计数。游离的CML通过唾液的ELISA测量。唾液中的表达细胞表面CML的颊细胞与游离的CML的比例为5:1。该比例大于健康的50岁的预期的比例,这证明该患者的生物学年龄大于她的实足年龄。结果表明该患者由于细胞衰老而正经历衰老以及衰老相关疾病、紊乱或病理状态的早发。这些结果还表明患者需要用衰老细胞去除剂进行治疗。
实施例7:与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态顺序的诊断和治疗
从45岁的患者获得血样。离心血样以分离血清。使用Miltenyi Biotec CD8+CD57+T细胞分离试剂盒(Bergisch Gladbach,德国)来分离CD57+T细胞。使用血细胞计数器对CD57+T细胞进行计数。然后测试血清和分离的CD57+T细胞与抗CML抗体的结合。血清中的表达细胞表面CML的细胞与游离的CML的比例为10:1。该比例表明患者的生物学年龄为65岁。由于患者的生物学年龄超过了该患者的实足年龄,因此该患者被诊断为患有与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态。对患者给予靶向并去除衰老细胞的抗AGE抗体。
实施例8:给予抗糖基化终末产物抗体的体内研究
为了检查抗糖基化终末产物抗体的作用,将抗体以每日两次通过静脉内注射给予至衰老的CD1(ICR)小鼠(Charles River实验室),每周一回,持续三周(第1天、第8天和第15天),随后是10周的无治疗期。测试抗体是针对与钥孔血蓝蛋白缀合的羧甲基赖氨酸产生的可商购的小鼠抗糖基化终末产物抗体,羧甲基赖氨酸MAb(克隆318003)可从R&D Systems,Inc.获得(Minneapolis,MN;货号MAB3247)。在对照动物中使用对照参考物生理盐水。
称为“年轻”的小鼠为8周龄,而称为“年老”的小鼠为88周龄(±2天)。从抗体的给予中未观察到不良事件。研究中使用的不同的动物组在表1中示出。
表1研究中使用的不同的动物组
-=不适用,Pre=在开始用于采集脂肪组织的处理前安乐死的动物子集。
通过实时qPCR对各组的脂肪组织中的衰老细胞的标志物P16INK4a mRNA进行定量。将结果在表2中示出。在该表中,ΔΔCt=ΔCt对照组(2)均值-ΔCt实验组(1或3或5)均值;倍数表达式(fold expression)=2-ΔΔCt。表2脂肪组织中定量的P16INK4a mRNA
上表表明如同所预期的,比起未经治疗的年轻小鼠(对照组1),未经治疗的年老小鼠(对照组2)表达高2.55倍的p16Ink4a mRNA。当将在恢复的第85天结束时安乐死的组2的未经治疗的年老小鼠和在治疗的第22天结束时安乐死的组1的未经治疗的年轻小鼠进行比较时,观察到该结果。当将来自组2的未经治疗的年老小鼠的结果与来自在第85天安乐死的组3的经治疗的年老小鼠的结果进行比较时,观察到组2中的p16Ink4a mRNA比起组3中高1.23倍。因此,当用2.5μg/g/BID/周的抗体对年老小鼠进行治疗时,p16Ink4a mRNA表达的水平较低。
当将来自组2(对照)的未经治疗的年老小鼠的结果与来自在第22天安乐死的组5(5μg/g)的经治疗的年老小鼠的结果进行比较时,观察到组2(对照)中的p16Ink4a mRNA比组5(5μg/g)高3.03倍。该比较表明当将其以5.0μg/g/BID/周进行处理时,组5动物具有较低水平的p16Ink4a mRNA表达,提供了与未经治疗的年轻小鼠(即,组1)相当的p16Ink4a mRNA表达水平。不同于在恢复的第85天结束时安乐死的组3(2.5μg/g)的小鼠,组5的小鼠在治疗的第22天进行安乐死。
这些结果证实给予抗AGE抗体使得杀死了衰老细胞。
还测量了腓肠肌的质量,以确定抗体给予对肌肉减少症的作用。结果在表3中提供。结果表明与对照相比,给予抗体增加了肌肉质量(但是仅在5.0μg/g/BID/周的较高剂量时)。
表3:抗体给予对腓肠肌质量的作用
这些结果表明,与细胞的AGE结合的抗体的给予引起表达p16Ink4a(衰老的生物标志物)的细胞减少。数据显示,减少衰老细胞直接引起衰老小鼠的肌肉质量增加。这些结果表明,可通过给予衰老细胞去除剂(例如与细胞的AGE结合的抗体)来治疗肌肉质量减少(肌肉减少症的经典征象)。
该数据证实抗AGE抗体能够选择性地结合至表达细胞表面经AGE修饰的蛋白质或经AGE修饰的肽的细胞。选择性结合的证据支持抗AGE抗体在诊断应用中的适用性。该数据还显示抗AGE抗体对于体内使用而言是安全的。
实施例9:测试抗体的亲和力和动力学
使用Na,Na-双(羧甲基)-L-赖氨酸三氟乙酸盐(Sigma-Aldrich,St.Louis,MO)作为用于细胞的经AGE修饰的蛋白的模型底物来分析实施例8中使用的测试抗体的亲和力和动力学。在BIACORETM T200(GE Healthcare,Pittsburgh,PA)上进行无标记的相互作用分析,采用S系列传感器芯片CM5(GE Healthcare,Pittsburgh,PA),伴随着Fc1设置为空白,以及将Fc2用测试抗体(分子量150,000Da)固定。运行缓冲液是在25℃的温度下的HBS-EP缓冲液(10mM HEPES、150mM NaCl、3mM EDTA和0.05%P-20,pH 7.4)。软件是BIACORETM T200评价软件2.0版。在分析中使用双重参考物(Fc2-1和仅缓冲液注射剂),并将数据拟合至Langmuir 1:1结合模型。
表4:亲和力和动力学分析的实验设置
图2中示出了相对于时间的应答的图。可从分析确定以下值:ka(1/Ms)=1.857×103;kd(1/s)=6.781×10-3;KD(M)=3.651×10-6;Rmax(RU)=19.52;以及Chi2=0.114。由于拟合的Chi2值小于Rmax的10%,因此拟合是可靠的。
实施例10:给予羧甲基赖氨酸单克隆抗体的体内研究
调查了羧甲基赖氨酸抗体对肿瘤生长、转移潜力和恶病质的作用。使用小鼠乳腺癌肿瘤模型在小鼠中进行了体内研究。在研究的第1天,雌性BALB/c小鼠(BALB/cAnNCrl,Charles River)为11周龄。
在含有10%胎牛血清、2mM谷氨酰胺、25μg/mL庆大霉素、100单位/mL青霉素G Na和100μg/mL链霉素硫酸盐的RPMI 1640培养基中培养4T1鼠类乳腺肿瘤细胞(ATCC CRL-2539)。将肿瘤细胞维持在组织培养瓶中,所述组织培养瓶处于37℃下、具有5%CO2和95%空气的气氛的加湿培养箱中。
然后将经培养的乳腺癌细胞植入小鼠。在对数生长期期间收集4T1细胞,并在植入当天以1×106个细胞/mL的浓度重悬于磷酸盐缓冲盐水(PBS)中。通过将1×105个4T1细胞(0.1mL悬液)皮下植入每只测试动物的右胁腹来引发肿瘤。当肿瘤的体积接近80-120mm3的目标范围时,对肿瘤进行监测。使用下式确定肿瘤体积,肿瘤体积=(肿瘤宽度)2(肿瘤长度)/2。使用1mm3肿瘤体积的重量为1mg的设定来概略估算肿瘤重量。植入后第13天(称为研究的第1天),将小鼠分为四组(n=15只/组),单个肿瘤体积范围为108至126mm3,并且组平均肿瘤体积为112mm3。四个治疗组示于下表5中:
表5:治疗组
组 | 描述 | 试剂 | 给药(μg/g) |
1 | 对照 | 磷酸盐缓冲盐水(PBS) | N/A |
2 | 低剂量 | 羧甲基赖氨酸单克隆抗体 | 5 |
3 | 高剂量 | 羧甲基赖氨酸单克隆抗体 | 10 |
4 | 仅观察 | 无 | N/A |
抗羧甲基赖氨酸单克隆抗体用作治疗剂。250mg羧甲基赖氨酸单克隆抗体获得自R&D Systems(Minneapolis,MN)。在赋形剂(PBS)中以1mg/mL和0.5mg/mL制备羧甲基赖氨酸单克隆抗体的给药溶液,从而以10mL/kg的给药体积分别提供10μg/g和5μg/g的活性剂量。将给药溶液在4℃下避光保存。
除了在研究的第1天对小鼠给予一剂外,所有治疗均每日两次静脉内(i.v.)给予,持续21天。在研究的第19天,对于由于尾静脉退化而无法i.v.给药的那些动物,将i.v.给药改为腹膜内(i.p.)给药。给药体积为每20克体重0.200毫升(10mL/kg),并与每只动物的体重成比例。
研究持续了23天。每周两次使用游标卡尺测量肿瘤。在第1天-第5天每天称重动物,然后每周两次称重直到研究结束。还观察小鼠的任何副作用。将可接受的毒性定义为研究期间的组体重减轻小于20%,并且治疗相关的死亡不超过10%。使用来自该研究的最后一天(第23天)的数据确定治疗功效。
通过比较组1-组3的中值肿瘤体积(MTV),确定抗羧甲基赖氨酸抗体抑制肿瘤生长的能力。如上所述测量肿瘤体积。将肿瘤生长抑制百分比(TGI%)定义为对照组(组1)的MTV与药物治疗组的MTV之间的差异,表示为对照组的MTV的百分比。可根据下式计算TGI%,TGI%=(1-MTV治疗/MTV对照)×100。
通过比较组1-组3的肺癌灶来确定抗羧甲基赖氨酸抗体抑制癌症转移的能力。将抑制百分比(抑制%)定义为对照组的转移灶的平均计数与药物治疗组的转移灶的平均计数之间的差,表示为对照组的转移灶的平均计数的百分比。可根据下式计算抑制%,抑制%=(1-转移灶治疗的平均计数/转移灶对照的平均计数)×100。
通过比较组1-组3的肺和腓肠肌的重量,确定抗羧甲基赖氨酸抗体抑制恶病质的能力。还将组织重量归一化为100克体重。
还通过研究期间观察到的消退应答的发生率和量级来评价治疗功效。治疗可能引起动物内的肿瘤部分消退(PR)或完全消退(CR)。在PR应答中,在研究过程中连续三次测量的肿瘤体积为其第1天体积的50%或更少,且这三次测量中的一次或多次的肿瘤体积等于或大于13.5mm3。在CR应答中,在研究过程中连续三次测量的肿瘤体积小于13.5mm3。
使用Windows版Prism 6.07(GraphPad)进行了统计分析。使用Mann-Whitney U检验完成两组的第23天平均肿瘤体积(MTV)之间的差异的统计分析。通过ANOVA-Dunnett来评估转移灶的比较。通过ANOVA来比较经归一化的组织重量。以显著性水平P=0.05进行了双尾统计分析。将结果分类为统计学显著的或统计学不显著的。
将研究的结果示于下表6中。
表6:结果
所有治疗方案可接受地容忍没有与治疗相关的死亡。仅有的动物死亡是由转移引起的与治疗无关的死亡。对于5μg/g(组2)治疗组和10μg/g治疗组(组3),TGI%趋于显著性(P>0.05,Mann-Whitney)。对于5μg/g治疗组,抑制%趋于显著性(P>0.05,ANOVA-Dunnett)。对于10μg/g治疗组,抑制%是统计学显著的(P<0.01,ANOVA-Dunnett)。基于治疗组和对照组之间的肺和腓肠肌的器官重量的比较,羧甲基赖氨酸抗体治疗恶病质的能力趋于显著性(P>0.05,ANOVA)。结果表明给予抗羧甲基赖氨酸单克隆抗体能够减少癌症转移。
该数据证实抗AGE抗体能够选择性地结合至表达细胞表面经AGE修饰的蛋白质或经AGE修饰的肽的细胞。选择性结合的证据支持抗AGE抗体在诊断应用中的适用性。数据还证明抗AGE抗体对于体内使用而言是安全的。
实施例11:抗AGE抗体在体外与衰老的软骨细胞结合
衰老的软骨细胞获得自骨关节炎关节。抗AGE抗体在体外与衰老的软骨细胞结合。这些结果证实了抗AGE抗体能够结合至衰老细胞。结果还证实了抗AGE抗体在诊断应用中的适用性。
实施例12:免疫组织化学研究
组织样本从患有阿尔茨海默病和帕金森病的患者获得。两个阿尔茨海默病样本取自海马体。一个帕金森病样本取自黑质,并且第二个帕金森病样本取自腹侧被盖区。如上所述,使用抗AGE抗体对所有细胞进行羧甲基赖氨酸(CML)染色。对阿尔茨海默病细胞进行磷酸化tau(phospho tau)或单独的淀粉样前体蛋白的染色。对帕金森病细胞进行α突触核蛋白染色。使用DAPI复染剂鉴别细胞的核染色。由亚利桑那州立大学的Diego Mastroeni博士进行了实验并准备了图像。
图3A是示出羧甲基赖氨酸染成的红色和磷酸化tau染成的绿色的阿尔茨海默病样本的细胞的照片。
图3B是示出羧甲基赖氨酸染成的红色和淀粉样前体蛋白染成的绿色的阿尔茨海默病样本的细胞的照片。
图3C是示出羧甲基赖氨酸染成的红色和α突触核蛋白染成的绿色的来自黑质的帕金森病样本的细胞的照片。
图3D是示出羧甲基赖氨酸染成的红色和α突触核蛋白染成的绿色的来自腹侧被盖区的帕金森病样本的细胞的照片。
CML(公知的AGE)并未与阿尔茨海默病和帕金森病中的既定病状共定位。CML反而出现在胶质细胞上。怀疑阿尔茨海默病样本中的CML免疫反应性与小胶质细胞有关,而帕金森病样本中的CML免疫反应性与星形胶质细胞有关。结果证明衰老的胶质细胞存在于阿尔茨海默病和帕金森病中。使用抗AGE抗体移除衰老的胶质细胞有望引起通过神经干/祖细胞再生胶质细胞,例如参见Leonard,B.W.等,“Subventricular zone neural progenitorsfrom rapid brain autopsies of elderly subjects with and withoutneurodegenerative disease”,The Journal of Comparative Neurology,Vol.515,pp.269-294(2009)。
该数据证实了抗AGE抗体与从患有各种神经退行性疾病的患者获得的组织样本中的细胞上存在的AGE结合的能力。该证据进一步证实了抗AGE抗体在诊断应用中的适用性。
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100 105 110
Claims (33)
1.一种诊断与患者中的细胞衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:
从所述患者获得样本;
测量所述样本中的显示出细胞表面AGE的细胞的数量;以及
当所述样本中的显示出细胞表面AGE的细胞的数量大于对照中的显示出细胞表面AGE的细胞的数量时,诊断所述患者患有与细胞衰老相关的疾病、紊乱或病理状态。
2.一种确定患者的生物学年龄的方法,所述方法包括:
从患者获得含有细胞和非细胞物质的样本;
将所述细胞与所述非细胞物质分离;
通过使所述细胞与抗AGE抗体接触并检测细胞表面AGE与所述抗AGE抗体之间的结合来测量所述样本中的显示出细胞表面AGE的细胞的数量;
通过使所述非细胞物质与抗AGE抗体接触并检测未结合的AGE与所述抗AGE抗体之间的结合来测量所述样本中的未结合的AGE的数量;以及
比较所述样本中的细胞表面AGE与未结合的AGE的比例。
3.一种诊断与由患者中的细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:
从患者获得含有细胞和非细胞物质的样本;
将所述细胞与所述非细胞物质分离;
通过使所述细胞与抗AGE抗体接触并检测细胞表面AGE与所述抗AGE抗体之间的结合来测量所述样本中的显示出细胞表面AGE的细胞的数量;
通过使所述非细胞物质与抗AGE抗体接触并检测未结合的AGE与所述抗AGE抗体之间的结合来测量样本中的未结合的AGE的数量;
比较所述样本中的细胞表面AGE与未结合的AGE的比例,以确定患者的生物学年龄;以及
当所述患者的生物学年龄超过所述患者的实足年龄时,诊断所述患者患有与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态。
4.一种诊断与由患者中的细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:
从所述患者获得样本;
测量所述样本中的显示出细胞表面AGE的细胞的数量;
通过比较所述样本中的显示出细胞表面AGE的细胞的数量与年龄匹配的对照中的显示出细胞表面AGE的细胞的数量,确定所述患者的生物学年龄;以及
当所述患者的生物学年龄大于所述患者的实足年龄时,诊断所述患者患有与由细胞衰老引起的高龄的生物学衰老相关的疾病、紊乱或病理状态。
5.一种在体内检测受试者中的经AGE修饰的细胞的方法,所述方法包括:
向所述受试者给予已用可检测标记进行标记的抗AGE抗体。
6.一种用于检测表达细胞表面晚期糖基化终末产物的细胞的试剂盒,所述试剂盒包括:
抗AGE抗体,
对照样本,以及
任选地,与所述抗AGE抗体结合的试剂。
7.如前述权利要求中任一项所述的方法,其中,所述样本选自于由唾液样本、颊拭子、血样、皮肤样本和尿样所组成的组。
8.如前述权利要求中任一项所述的方法,其中,所述细胞选自于由T细胞、红细胞、成纤维细胞和上皮细胞所组成的组。
9.如前述权利要求中任一项所述的方法,其中,所述测量包括ELISA、细胞分选或细胞计数。
10.如前述权利要求中任一项所述的方法,其中,所述诊断包括:当所述样本中的至少5%的细胞显示出细胞表面AGE时,诊断所述患者患有与细胞衰老相关的疾病、紊乱或病理状态。
11.如前述权利要求中任一项所述的方法,其中,所述诊断包括:当所述样本中的至少25%的细胞显示出细胞表面AGE时,诊断所述患者患有与细胞衰老相关的疾病、紊乱或病理状态。
12.如前述权利要求中任一项所述的方法,其中,所述与细胞衰老相关的疾病、紊乱或病理状态包括选自于由如下所组成的组中的至少一种疾病、紊乱或病理状态:阿尔茨海默病、肌萎缩侧索硬化症、慢性阻塞性肺病、亨廷顿舞蹈病、特发性肺纤维化、肌肉营养不良、黄斑变性、白内障、糖尿病性视网膜病变、帕金森病、早衰症、白癜风、囊性纤维化、特应性皮炎、湿疹、关节炎、动脉粥样硬化、癌症和转移性癌症、癌症治疗相关的失能或癌症治疗副作用、高血压、青光眼、骨质疏松症、肌肉减少症、恶病质、中风、心肌梗塞、心房纤颤、移植排斥、I型糖尿病、II型糖尿病、辐射暴露、HIV治疗副作用、化学武器暴露、中毒、炎症、肾病、路易体痴呆、朊病毒病、驼背病、自身免疫紊乱、脂肪组织缺损、牛皮癣、克罗恩病、哮喘、衰老的生理影响、特发性肌病、多发性硬化症、视神经脊髓炎、癫痫和肾上腺白质营养不良。
13.如前述权利要求中任一项所述的方法,其中,所述抗AGE抗体结合至显示出AGE修饰的细胞表面蛋白或肽,所述AGE修饰选自于由FFI、吡咯素、AFGP、ALI、羧甲基赖氨酸、羧乙基赖氨酸和戊糖素所组成的组。
14.如前述权利要求中任一项所述的方法,其中,所述抗AGE抗体结合经羧甲基赖氨酸修饰的蛋白质或肽。
15.如前述权利要求中任一项所述的方法,其中,所述抗AGE抗体结合经羧乙基赖氨酸修饰的蛋白质或肽。
16.如前述权利要求中任一项所述的方法,其中,所述抗AGE抗体包括:
重链,以及
轻链,
其中,所述重链包含与SEQ ID NO:1的氨基酸序列具有至少90%的序列同一性、优选至少95%的序列同一性、更优选至少98%的序列同一性的氨基酸序列,并且
所述轻链包含与SEQ ID NO:3的氨基酸序列具有至少90%的序列同一性、优选至少95%的序列同一性、更优选至少98%的序列同一性的氨基酸序列。
17.如前述权利要求中任一项所述的方法,其中,所述患者选自于由人、小鼠、大鼠、山羊、绵羊、牛、马、骆驼、狗和猫所组成的组。
18.如前述权利要求中任一项所述的方法,其中,所述患者是人。
19.如前述权利要求中任一项所述的方法,所述方法进一步包括将所述受试者暴露至能够检测所述标记的设备。
20.如前述权利要求中任一项所述的方法,其中,所述经AGE修饰的细胞是衰老细胞。
21.如前述权利要求中任一项所述的方法,其中,所述经AGE修饰的细胞是转移性癌细胞。
22.如前述权利要求中任一项所述的方法,其中,所述标记包括选自于由如下所组成的组中的至少一种标记:放射性标记、荧光标记、金纳米颗粒、钆纳米颗粒、正电子发射体、近红外发射的染料、量子点、超顺磁氧化铁、碳纳米管和微泡。
23.如前述权利要求中任一项所述的试剂盒,所述试剂盒进一步包括与所述抗AGE抗体结合的试剂。
24.如前述权利要求中任一项所述的试剂盒,其中,所述试剂包括第二抗体。
25.如前述权利要求中任一项所述的试剂盒,其中,所述抗AGE抗体、所述对照样本和所述试剂是无菌的。
26.如前述权利要求中任一项所述的试剂盒,所述试剂盒进一步包括容器,其中,所述抗AGE抗体、所述对照样本和所述试剂处于所述容器中。
27.如前述权利要求中任一项所述的试剂盒,其中,将所述抗AGE抗体和/或所述试剂进行标记。
28.如前述权利要求中任一项所述的试剂盒,其中,所述标记包括选自于由荧光标记、放射性标记和金颗粒所组成的组中的至少一种标记。
29.如前述权利要求中任一项所述的方法,所述方法进一步包括向经诊断的患者给予有效量的衰老细胞去除剂。
30.如前述权利要求中任一项所述的方法,其中,所述衰老细胞去除剂包括治疗性抗AGE抗体、缀合至毒素的抗AGE抗体、senolytic试剂及其组合。
31.一种用于治疗与患者中的细胞衰老相关的疾病、紊乱或病理状态的衰老细胞去除剂,其中,所述患者的生物学年龄超过所述患者的实足年龄。
32.如前述权利要求中任一项所述的衰老细胞去除剂,其中,所述患者的生物学年龄使用上述的方法确定。
33.一种治疗与患者中的细胞衰老相关的疾病、紊乱或病理状态的方法,所述方法包括:
向有需要的患者给予治疗有效量的衰老细胞去除剂,
其中,所述患者的生物学年龄超过所述患者的实足年龄。
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