EP1685408A1 - Quick test for the diagnosis of alzheimer' disease - Google Patents

Quick test for the diagnosis of alzheimer' disease

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Publication number
EP1685408A1
EP1685408A1 EP04765688A EP04765688A EP1685408A1 EP 1685408 A1 EP1685408 A1 EP 1685408A1 EP 04765688 A EP04765688 A EP 04765688A EP 04765688 A EP04765688 A EP 04765688A EP 1685408 A1 EP1685408 A1 EP 1685408A1
Authority
EP
European Patent Office
Prior art keywords
disease
cells
stimulation
antibody
alzheimer
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Application number
EP04765688A
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German (de)
French (fr)
Inventor
Thomas Arendt
Jens Stieler
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Universitaet Leipzig
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Universitaet Leipzig
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Publication of EP1685408A1 publication Critical patent/EP1685408A1/en
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Classifications

    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
    • G01N33/6893—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids related to diseases not provided for elsewhere
    • G01N33/6896—Neurological disorders, e.g. Alzheimer's disease
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/02—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving viable microorganisms
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
    • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
    • G01N33/5044—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving specific cell types
    • G01N33/5047—Cells of the immune system
    • G01N33/505—Cells of the immune system involving T-cells
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70503—Immunoglobulin superfamily, e.g. VCAMs, PECAM, LFA-3
    • G01N2333/70514—CD4
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70503—Immunoglobulin superfamily, e.g. VCAMs, PECAM, LFA-3
    • G01N2333/70517—CD8
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/7056—Selectin superfamily, e.g. LAM-1, GlyCAM, ELAM-1, PADGEM
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/28—Neurological disorders
    • G01N2800/2814—Dementia; Cognitive disorders
    • G01N2800/2821—Alzheimer

Definitions

  • the present invention relates to a method for diagnosing Alzheimer's disease or an early stage or a predisposition for this disease, which is based on the quantitative determination of mitogenically expressible surfaces of ark, preferably CD69, peripherally accessible cells, e.g. Skin cells or lymphocytes, (a) before and (b) after mitogenic stimulation, a specific stimulation index a: b being a sign of Alzheimer's disease or an early stage or a predisposition to this disease.
  • the present invention also relates to kits which are suitable for carrying out the diagnostic method according to the invention.
  • Alzheimer's disease cannot be made with absolute certainty using clinical means and the available paraclinic and technical equipment alone and therefore always requires autoptical verification.
  • it is often difficult to differentiate between other causes of dementia.
  • a reliable diagnosis is important for two reasons.
  • it allows the demarcation of potentially treatable forms of dementia and can thus lead to effective therapy
  • it is a prerequisite for any form of therapeutic intervention in the process of neurodegeneration of Alzheimer's disease, which can only be successful in these early stages.
  • Such diagnostic certainty can only be achieved through biomarkers of Alzheimer's disease, ie through easy to determine biological changes with a sensitivity and specificity sufficient for the disease.
  • biomarkers of Alzheimer's disease have a diagnostic value and are intended to help in particular to reliably identify risk groups and patients in preclinical and early clinical stages.
  • biomarkers serve to monitor the progress and thus the prognosis and the control of the responsiveness to therapeutic interventions.
  • Ideal biomarkers should meet certain theoretical and practical requirements. In particular, this includes a high degree of specificity and sensitivity, the ability to identify preclinical stages, as well as a high positive and negative predictive value.
  • the determination of the biomarkers should be as non-invasive as possible and should not burden or frighten the patient.
  • the analyzes should be inexpensive and simple, if possible under the conditions of the family doctor's practice.
  • none of the currently known biomarkers of Alzheimer's disease meet the above requirements. In particular due to the low sensitivity and specificity of the known biomarkers, they are unsuitable as diagnostic aids. Other diagnostic tests with higher sensitivity and specificity require complex technical requirements and are therefore not suitable for decentralized use in a larger group of patients.
  • the invention is essentially based on the technical problem of providing a simple method for diagnosing Alzheimer's disease, which allows the diagnosis of Alzheimer's disease, the detection of preclinical disease phases and the differential diagnosis of Alzheimer's disease against other dementias with sufficient sensitivity and specificity.
  • a diagnostic procedure could be developed which is based on the determination of the mitogenic index (activation index) on peripherally accessible cells, such as skin cells or blood lymphocytes, of the patient with and without mitogenic stimulation, for example after immunomagnetic cell separation.
  • the activation of these cells is accompanied by the surface presentation of activation markers which can be detected quantitatively, preferably on the basis of antigen-antibody interactions, preferably using magnetic particles coated with antibodies, which allows the magnetic cell separation and subsequent quantification of the number of cells, that carry this surface marker before and after mitogenic stimulation.
  • This characteristic shows disease-specific deviations from normal findings.
  • the method according to the invention thus allows the diagnosis of Alzheimer's disease, the detection of preclinical phases of the disease and the differential diagnosis of Alzheimer's disease against other dementias.
  • the present invention thus relates to a method for diagnosing Alzheimer's disease or an early stage or a predisposition for this disease on the basis of a sample from a patient, said method comprising the following steps: (a) mitogenic stimulation of the peripherally accessible cells in the sample; (b) quantitative determination of the mitogenically stimulated cells within the cell population before and after step (a) on the basis of one or more surface markers expressed after mitogenic stimulation, the cells bearing the surface markers from the cells bearing no surface markers using cells which are directed against the surface markers Antibodies are separated; and (c) Determination of the stimulation index as a ratio of the number of cells carrying the surface area marker (s) before and after step (a), wherein a stimulation index that reaches at least 10 times and at most 100 times the unstimulated control sample is an indication of a Alzheimer's disease or an early stage or predisposition to this disease.
  • suitable samples are skin tissue samples, blood samples, preferably of venous blood, cells from the cerebrospinal fluid, and cells from urine.
  • a coagulation-inhibiting compound e.g. sodium citrate or heparin, is added for stabilization before the further method steps.
  • diagnosis of Alzheimer's disease also includes the follow-up and thus prognostics, the control of the efficiency of therapeutic measures and the differential diagnosis of the disease from other dementias.
  • peripheral blood refers to cells that can be removed from the human organism without surgical intervention or (minimally) invasively and include, for example, skin cells and lymphocytes of the peripheral blood, the latter for the method according to the invention are preferred.
  • Mitogenic stimulation to achieve the expression of the expression of surface markers can be carried out by known stimulators, such as phytohemagglutinin (PHA), protein A, PWM or other trophic or mitogenic compounds. The stimulation can take place by adding the individual compounds or by combined addition.
  • PHA phytohemagglutinin
  • PWM phytohemagglutinin
  • mitogenic compounds can take place by adding the individual compounds or by combined addition.
  • suitable experimental conditions for such stimulation e.g. with regard to the concentration of the mitogens used, duration of the stimulation and other incubation conditions.
  • the stimulation should take place in suitable vessels that allow sufficient gas exchange.
  • concentrations of the respective stimulation agents should be in the physiological range, e.g. for PHA l ⁇ g / ml to 20 ⁇ g / ml, for PWM l ⁇ g / ml to 50 ⁇ g / ml and for protein A lO ⁇ g / ml to 200 ⁇ g / ml.
  • the duration of the stimulation depends on the speed of expression of the molecule to be examined.
  • stimulation times of 2 to 24 hours may also be required; in the case of CD69, a stimulation period of 4 hours is optimal.
  • the stimulation should take place under physiological conditions and can e.g. be carried out in a fumigation incubator at 37 ° C and 5% C02.
  • suitable surface markers on the basis of which a mitogenic stimulation is manifested for example CD69, CD25, CD45RO, CD63 or HLA-DR, the surface marker CD69 being preferred.
  • the stimulation index results from the ratio of the number of cells carrying the surface marker or markers before and after stimulation.
  • a stimulation index that is at least 10 times and at most 100 times the unstimulated control sample is a sign of Alzheimer's disease or an early stage or a predisposition to this disease.
  • a stimulation index that is less than 10 times The unstimulated control sample does not indicate any signs of Alzheimer's disease or an early stage or a predisposition to this disease.
  • the cells carrying surface markers can be determined by conventional methods, for example Western blot, ELISA, RIA, FACS, LSC etc.
  • the cell carrying surface markers For the determination of the cell carrying surface markers, it is preferable to separate them from the cells bearing no surface markers or other surface markers on the basis of characteristic cell features.
  • the separation of the cells bearing surface markers from the cells not bearing surface markers is carried out by antibodies directed against the desired surface marker.
  • the suitable antibodies can be monoclonal, polyclonal or synthetic antibodies or fragments thereof.
  • fragment means all parts of the monoclonal antibody (e.g. Fab, Fv or “single chain Fv” fragments) which have the same epitope specificity as the complete antibody. The preparation of such fragments is known to the person skilled in the art, and many antibodies directed against surface markers are also commercially available.
  • the surface margin (s) is Ker-specific antibodies are bound to magnetic particles, for example paramagnetic beads (for example available from DYNAL AS, POBox 158 Sk0yen, N-0212 Oslo, Norway), which makes the separation of the cells with the corresponding surface markers via immuno-magnetic separation according to the usual method Allow procedure.
  • paramagnetic beads for example available from DYNAL AS, POBox 158 Sk0yen, N-0212 Oslo, Norway
  • the stimulation index can then be determined by determining the amount of cells separated by means of the desired surface marker on the basis of their nucleic acid content and / or protein content by means of common methods, e.g. after lysis of the cells by spectrophotometric determination of the nucleic acid or protein content or after staining of the nucleic acid using specific dyes, e.g. Ethidium bromide, propidium odid, acridine orange, DAPI etc. via photometric quantification. Using calibration curves, the cell number can be calculated from the protein and / or nucleic acid content of the sample.
  • the present invention also relates to a kit which is suitable for carrying out the diagnostic method according to the invention and contains at least the following components: (a) a compound for mitogenic stimulation; (b) at least one antibody directed against a surface marker expressed after mitogenic stimulation, preferably an antibody bound to a magnetic particle.
  • the kit according to the invention preferably also contains (a) at least one reaction vessel; (b) an anticoagulant compound and / or a buffer for cell lysis; (c) a buffer to fix the cells; (d) substances which are required for the quantitative determination of the DNA or protein concentration, as well as ready-made solutions for producing a calibration curve; (e) a magnet for separating the cells bound to the magnetic particles (included if an antibody bound to a magnetic particle is used); and (f) a reagent for detaching bound magnetic particles (included if an antibody bound to a magnetic particle is used)
  • the antibody is an anti-CD69 antibody.
  • the kit may also contain an anti-CD4 and / or anti-CD8 antibody in addition to or instead of the anti-CD-69 antibody.
  • kit according to the invention can optionally be combined with one or more suitable further detection means, e.g. fluorescence-coupled primary antibodies, secondary antibodies, detection means for proteins and / or nucleic acids, e.g. an intercalating dye, etc.
  • suitable further detection means e.g. fluorescence-coupled primary antibodies, secondary antibodies, detection means for proteins and / or nucleic acids, e.g. an intercalating dye, etc.
  • biomarkers Determinations of previously known features of Alzheimer's disease that can be carried out on living patients (biomarkers) show only insufficient sensitivity and specificity or are not suitable for investigations with high numbers of cases for reasons of cost or the high complexity of the test arrangement. With clinical means, the dia- Gnostic certainty only 80% to 90% and causes differential diagnostic difficulties, especially in the early stages of the disease. The detection of preclinical disease phases is currently not possible due to the lack of a suitable biomarker.
  • Alzheimer's disease the neurodegenerative changes are based on impaired processes of intracellular mediation of trophic and mitogenic signals. These disorders of intracellular signal transduction are not limited to the nervous system. They can also be found in a similar manner on skin cells and on lymphocytes in the peripheral blood of these patients. Because of its disease specificity, this change has diagnostic value and is suitable as a biomarker.
  • lymphocytes presenting CD69 presenting immuno-magnetic cell separation before and after mitogenic stimulation it was determined whether the disturbance in intracellular mediation of trophic and mitogenic signals typical of Alzheimer's disease is present by lymphocytes presenting CD69 presenting immuno-magnetic cell separation before and after mitogenic stimulation.
  • the blood was obtained by venipuncture using a SARSTEDT blood collection system.
  • the blood is stabilized during the withdrawal by anticoagulants integrated in the blood collection system, such as sodium citrate or sodium heparin. In this form it can be stored at room temperature for 24 to 48 hours.
  • anticoagulants integrated in the blood collection system such as sodium citrate or sodium heparin. In this form it can be stored at room temperature for 24 to 48 hours.
  • the stimulation experiments were carried out in well-ventilated reaction vessels, such as a 24 well suspension culture plate from Greiner bio-one.
  • the mitogens phytohaemagglutinin (PHA), protein A and Pokeweed mitogen (PWM) were used individually or in different combinations for 400 ⁇ l of stabilized whole blood.
  • the final concentrations of the respective mitogens were in the physiological range and in this example was 12 ⁇ g / ml for PHA, 50 ⁇ g / ml for Protein A and 4 ⁇ g / ml for PWM.
  • the stimulation was carried out under physiological conditions at 37 ° C. and a CO 2 concentration of 5% in a fumigation incubator for a period of 4 hours.
  • 100 ⁇ l of the stimulated whole blood were incubated with various antibody-coated magnetic particles.
  • anti-CD4 and anti-CD8 coated magnetic particles from DYNAL were used.
  • the corresponding magnetic particles were added to the respective sample in excess (10 ⁇ l magnetic particle suspension) in order to ensure complete isolation of the corresponding lymphocyte subpopulation.
  • the corresponding lymphocyte subpopulation was magnetically separated and, after subsequent washing steps, transferred to 100 ⁇ l of defined medium, in this example RPMI1640, mixed with 1% fetal calf serum (FCS).
  • FCS fetal calf serum
  • the bound magnetic particles were detached using 10 ⁇ l DETACHaBEAD from DYNAL. After an incubation time of 45 minutes at room temperature, the detached magnetic particles were separated and the cell suspension was taken up in a defined medium, in this example RPMI1640, after washing several times.
  • the cells were disrupted by adding a specific lysis buffer, the DNA was labeled with specific DNA dyes, such as, for example, ethidium bromide, propidium iodide, acridine orange or DAPI, and these were then quantified photometrically.
  • DNA dyes such as, for example, ethidium bromide, propidium iodide, acridine orange or DAPI.
  • the protein content of the samples was compared using the Bradford protein determination method. Using calibration curves, the cell number was calculated from the DNA and / or protein content of the sample. This procedure allowed a direct conclusion to be drawn about the cell number.
  • the calculation of the quotient from the number of cells presenting CD69 before and after mitogenic stimulation provided information about changes in mitogenic stimulability of these cells.
  • a stimulation index that is at least 10 times and at most 100 times the unstimulated control sample is a sign of Alzheimer's disease or an early stage or a predisposition to this disease. • A stimulation index less than 10 times that of the unstimulated control sample does not indicate any signs of Alzheimer's disease or early stage or predisposition to this disease.
  • the protein content of the sample was determined, and the DNA content was determined without the addition of DNA-staining substances for the quantitative determination of the CD69-presenting cells.
  • the absorption of DNA or protein by light of a certain wavelength e.g. 260 nm or 280 nm was measured.

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Abstract

The invention relates to method for the diagnosis of Alzheimer's disease or the early stages thereof or a predisposition to said disease. Said method is based on quantitative determination of a mitogenically expressible surface marker, in particular CD69, and peripherally accessible cells, e.g. skin cells or lymphocytes, (a) prior to and (b) after mitogenic stimulation. A specific stimulation index a:b is an indication of Alzheimer's disease or early stages thereof or of a predisposition to said disease. The invention also relates to kits which are suitable for carrying out the inventive method of diagnosis.

Description

Schnelltest zur Diagnose der Alzheimerschen Erkrankung Quick test to diagnose Alzheimer's disease
Die vorliegende Erfindung betrifft ein Verfahren zur Diagnose der Alzheimerschen Erkrankung oder eines Frühstadiums oder einer Prädisposition für diese Erkrankung, das auf der quantitativen Bestimmung mitogen exprimierbarer Oberflächen arker, vorzugsweise CD69, peripher zugänglicher Zellen, z.B. Hautzellen oder Lymphozyten, (a) vor und (b) nach mitogener Stimulation erfolgt, wobei ein bestimmter Stimulationsindex a:b ein Anzeichen für Alzheimersche Erkrankung oder ein Frühstadium oder eine Prädisposition für diese Erkrankung ist. Die vorliegende Erfindung betrifft auch Kits, die zur Durchführung des erfindungsgemäßen Diagnoseverfahrens geeignet sind.The present invention relates to a method for diagnosing Alzheimer's disease or an early stage or a predisposition for this disease, which is based on the quantitative determination of mitogenically expressible surfaces of ark, preferably CD69, peripherally accessible cells, e.g. Skin cells or lymphocytes, (a) before and (b) after mitogenic stimulation, a specific stimulation index a: b being a sign of Alzheimer's disease or an early stage or a predisposition to this disease. The present invention also relates to kits which are suitable for carrying out the diagnostic method according to the invention.
Die Diagnose der Alzheimerschen Erkrankung ist mit klinischen Mitteln sowie den zur Verfügung stehenden paraklinischen und apparativ-technischen Methoden allein nicht mit letzter Sicherheit zu stellen und bedarf daher stets der autoptischen Verifizierung. Insbesondere in Frühstadien der Erkrankung ist die differentialdiagnostische Abgrenzung anderer Demenzursachen oft schwierig. Gerade in diesen frühen Phasen der Erkrankung ist jedoch eine sichere Stellung der Diagnose aus zweierlei Gründen wichtig. Sie erlaubt zum einen die diagnostische Abgrenzung potentiell behandelbarer Demenzformen und kann diese damit einer effektiven Therapie zuführen, zum anderen ist sie Voraussetzung für jegliche Form der therapeutischen Intervention in den Prozess der Neurodegeneration der Alzheimerschen Erkrankung, der nur in diesen Frühstadien erfolgreich sein kann. Eine derartige diagnostische Sicherheit kann nur durch Biomarker der Alzheimerschen Erkrankung, d.h. durch leicht zu bestimmende biologische Veränderungen mit einer für die Erkrankung hinreichenden Sensitivität und Spezifität, geleistet werden. Biomarker der Alzheimerschen Erkrankung haben damit zum einen diagnostischen Wert, und sollen hierbei insbesondere helfen, Risikogruppen bzw. Patienten in präklinischen Stadien und frühen klinischen Stadien sicher zu identifizieren. Zum anderen dienen Biomarker der Verlaufskontrolle und damit der Prognostik sowie der Kontrolle der Ansprechbarkeit auf therapeutische Interventionen. Ideale Biomarker sollten bestimmten theoretischen und praktischen Anforderungen genügen. Hierzu gehören insbesondere eine hohe Spezifität und Sensitivität, die Fähigkeit, präklinische Stadien zu identifizieren, sowie ein hoher positiver und negativer Vorhersagewert. Die Bestimmung der Biomarker sollte möglichst nicht-invasiv sein und den Patienten nicht belasten oder ängstigen. Die Analysen sollten preiswert sein und sich einfach, möglichst unter Bedingungen der Hausarztpraxis, durchführen lassen. Leider genügt keiner der derzeit bekannten Biomarker der Alzheimerschen Erkrankung den o.g. Anforderungen. Insbesondere aufgrund der geringen Sensitivität und Spezifität der bekannten Biomarker sind diese als diagnostisches Hilfsmittel ungeeignet. Andere diagnostische Untersuchungen mit höherer Sensitivität und Spezifität erfordern aufwendige technische Voraussetzungen und sind daher nicht zum dezentralen Einsatz an einer größeren Patientengruppe geeignet.The diagnosis of Alzheimer's disease cannot be made with absolute certainty using clinical means and the available paraclinic and technical equipment alone and therefore always requires autoptical verification. In the early stages of the disease in particular, it is often difficult to differentiate between other causes of dementia. However, it is precisely in these early phases of the disease that a reliable diagnosis is important for two reasons. On the one hand, it allows the demarcation of potentially treatable forms of dementia and can thus lead to effective therapy, on the other hand, it is a prerequisite for any form of therapeutic intervention in the process of neurodegeneration of Alzheimer's disease, which can only be successful in these early stages. Such diagnostic certainty can only be achieved through biomarkers of Alzheimer's disease, ie through easy to determine biological changes with a sensitivity and specificity sufficient for the disease. On the one hand, biomarkers of Alzheimer's disease have a diagnostic value and are intended to help in particular to reliably identify risk groups and patients in preclinical and early clinical stages. On the other hand, biomarkers serve to monitor the progress and thus the prognosis and the control of the responsiveness to therapeutic interventions. Ideal biomarkers should meet certain theoretical and practical requirements. In particular, this includes a high degree of specificity and sensitivity, the ability to identify preclinical stages, as well as a high positive and negative predictive value. The determination of the biomarkers should be as non-invasive as possible and should not burden or frighten the patient. The analyzes should be inexpensive and simple, if possible under the conditions of the family doctor's practice. Unfortunately, none of the currently known biomarkers of Alzheimer's disease meet the above requirements. In particular due to the low sensitivity and specificity of the known biomarkers, they are unsuitable as diagnostic aids. Other diagnostic tests with higher sensitivity and specificity require complex technical requirements and are therefore not suitable for decentralized use in a larger group of patients.
Somit liegt der Erfindung im wesentlichen das technische Problem zugrunde, ein einfaches Verfahren zur Diagnose der Alzheimerschen Erkrankung bereitzustellen, das die Diagnose der Alzheimerschen Erkrankung, die Erfassung von präklinischen Erkrankungsphasen sowie die differentialdiagnostische Abgrenzung der Alzheimerschen Erkrankung gegen andere Demenzen mit ausreichender Sensitivität und Spezifität erlaubt.Thus, the invention is essentially based on the technical problem of providing a simple method for diagnosing Alzheimer's disease, which allows the diagnosis of Alzheimer's disease, the detection of preclinical disease phases and the differential diagnosis of Alzheimer's disease against other dementias with sufficient sensitivity and specificity.
Die Lösung dieses technischen Problems wurde durch die Bereitstellung der in den Patentansprüchen gekennzeichneten Ausführungsformen erreicht. Es konnte ein Diagnoseverfahren entwickelt werden, das auf der Bestimmung des mitogenen Index (Aktivierungsindex) an peripher zugänglichen Zellen, wie Hautzellen oder Blutlymphozyten, des Patienten mit und ohne mitogener Stimulation beispielsweise nach immuno-magnetischer Zellseparation basiert. Die Aktivierung dieser Zellen geht mit der Oberflächenpräsentation von Aktivierungsmarkern einher, die quantitativ nachgewiesen werden können, vorzugsweise anhand von Antigen-Antikörper- Wechselwirkungen, wobei vorzusgweise mit Antikörpern beschichtete magnetische Partikeln verwendet werden, was die magnetische Zellseparation und anschließende Quantifizierung der Anzahl der Zellen erlaubt, die diesen Oberflächenmarker vor und nach mitogener Stimulation tragen. Dieses Merkmal zeigt erkrankungsspezifische Abweichungen vom Normalbefund. Das erfindungsgemäße Verfahren erlaubt somit die Diagnose der Alzheimerschen Erkrankung, die Erfassung von präklinischen Erkrankungsphasen sowie die differentialdiagnostische Abgrenzung der Alzheimerschen Erkrankung gegen andere Demenzen.The solution to this technical problem has been achieved by providing the embodiments characterized in the patent claims. A diagnostic procedure could be developed which is based on the determination of the mitogenic index (activation index) on peripherally accessible cells, such as skin cells or blood lymphocytes, of the patient with and without mitogenic stimulation, for example after immunomagnetic cell separation. The activation of these cells is accompanied by the surface presentation of activation markers which can be detected quantitatively, preferably on the basis of antigen-antibody interactions, preferably using magnetic particles coated with antibodies, which allows the magnetic cell separation and subsequent quantification of the number of cells, that carry this surface marker before and after mitogenic stimulation. This characteristic shows disease-specific deviations from normal findings. The method according to the invention thus allows the diagnosis of Alzheimer's disease, the detection of preclinical phases of the disease and the differential diagnosis of Alzheimer's disease against other dementias.
Somit betrifft die vorliegende Erfindung ein Verfahren zur Diagnose der Alzheimerschen Erkrankung oder eines Frühstadiums oder einer Prädisposition für diese Erkrankung anhand einer Probe von einem Patienten, wobei dieses Verfahren die folgenden Schritte umfasst: (a) mitogene Stimulation der peripher zugänglichen Zellen in der Probe; (b) quantitative Bestimmung der mitogen stimulierten Zellen innerhalb der Zellpopulation vor und nach Schritt (a) anhand von einem oder mehreren nach mitogener Stimulation exprimierten Oberflächenmarkern, wobei die Oberflächenmarker tragenden Zellen von den keinen Oberflächenmarker tragenden Zellen unter Verwendung von gegen die Oberflächen- marker gerichteten Antikörpern separiert werden; und (c) Bestimmung des Stimulationsindex als Verhältnis der Anzahl der den oder die Oberflächenflächenmarker tragenden Zellen vor und nach Schritt (a) , wobei ein Stimulationsindex, der mindestens das 10-fache, maximal das 100-fache der unstimulierten Kontrollprobe erreicht, ein Anzeichen für eine Alzheimersche Erkrankung oder ein Frühstadiums oder eine Prädisposition für diese Erkrankung ist.The present invention thus relates to a method for diagnosing Alzheimer's disease or an early stage or a predisposition for this disease on the basis of a sample from a patient, said method comprising the following steps: (a) mitogenic stimulation of the peripherally accessible cells in the sample; (b) quantitative determination of the mitogenically stimulated cells within the cell population before and after step (a) on the basis of one or more surface markers expressed after mitogenic stimulation, the cells bearing the surface markers from the cells bearing no surface markers using cells which are directed against the surface markers Antibodies are separated; and (c) Determination of the stimulation index as a ratio of the number of cells carrying the surface area marker (s) before and after step (a), wherein a stimulation index that reaches at least 10 times and at most 100 times the unstimulated control sample is an indication of a Alzheimer's disease or an early stage or predisposition to this disease.
Der Fachmann kennt geeignete Maßnahmen, um für das erfindungsgemäße Verfahren geeignete Patientenproben zu erhalten und die mitogen stimulierbare Zellen in ausreichendem Maß enthalten, beispielsweise sind geeignete Proben Hautgewebeproben, Blutproben, vorzugsweise von venösem Blut, Zellen aus dem Liquor cerebrospinalis, sowie Zellen aus Urin.The person skilled in the art knows suitable measures to obtain suitable patient samples for the method according to the invention and contain the mitogenically stimulable cells to a sufficient extent, for example suitable samples are skin tissue samples, blood samples, preferably of venous blood, cells from the cerebrospinal fluid, and cells from urine.
In einer bevorzugten Ausführungsform des erfindungsgemäßen Diagnoseverfahrens, z.B., bei Verwendung einer Blutprobe, erfolgt zur Stabilisierung vor den weiteren Verfahrensschritten die Zugabe einer koagulationshemmenden Verbindung, z.B., Nat- riu citrat oder Heparin.In a preferred embodiment of the diagnostic method according to the invention, e.g. when using a blood sample, a coagulation-inhibiting compound, e.g. sodium citrate or heparin, is added for stabilization before the further method steps.
Der hier verwendete Begriff „Diagnose der Alzheimerschen Erkrankung" umfasst auch die Verlaufskontrolle und somit Prognostik, die Kontrolle der Effizienz therapeutischer Maßnahmen und die differentialdiagnostische Abgrenzung der Erkrankung von anderen Demenzen.The term "diagnosis of Alzheimer's disease" used here also includes the follow-up and thus prognostics, the control of the efficiency of therapeutic measures and the differential diagnosis of the disease from other dementias.
Der hier verwendet Begriff „peripher zugängliche Zellen" bezieht sich auf Zellen, die ohne operative Eingriffe, oder aber (minimal) invasiv dem menschlichen Organismus entnommen werden können und dazu zählen beispielsweise Hautzellen und Lymphozy- ten der peripheren Bluts, wobei letztere für das erfindungsgemäße Verfahren bevorzugt sind. Die mitogene Stimulation zur Erzielung der Expression der Expression von Oberflächenmarkern kann durch bekannte Stimulato- ren erfolgen, wie z.B. Phytohämagglutinin (PHA) , Protein A, PWM oder andere trophisch oder mitogen wirkende Verbindungen. Die Stimulation kann durch Zugabe der Einzelverbindungen oder durch kombinierte Zugabe erfolgen.The term "peripherally accessible cells" used here refers to cells that can be removed from the human organism without surgical intervention or (minimally) invasively and include, for example, skin cells and lymphocytes of the peripheral blood, the latter for the method according to the invention are preferred. Mitogenic stimulation to achieve the expression of the expression of surface markers can be carried out by known stimulators, such as phytohemagglutinin (PHA), protein A, PWM or other trophic or mitogenic compounds. The stimulation can take place by adding the individual compounds or by combined addition.
Der Fachmann kennt geeignete experimentelle Bedingungen für eine solche Stimulation, z.B. hinsichtlich der Konzentration der verwendeten Mitogene, Dauer der Stimulation und sonstigen Inkubationsbedingungen. Dabei sollte die Stimulation in geeigneten Gefäßen erfolgen, die einen ausreichenden Gasaustausch zulassen. Die Konzentrationen der jeweiligen Stimulationsagen- tien sollten sich im physiologischen Bereich befinden, der z.B. für PHA lμg/ml bis 20μg/ml, für PWM lμg/ml bis 50μg/ml und für Protein A lOμg/ml bis 200μg/ml beträgt. Die Dauer der Stimulation richtet sich nach der Geschwindigkeit der Expression des zu untersuchenden Moleküls. Für bestimmte Untersuchungen können aber auch Stimulationszeiten von 2 bis 24 Sunden erforderlich sein; im Falle von CD69 ist eine Stimulationsdauer von 4 Stunden optimal. Die Stimulation sollte unter physiologischen Bedingungen erfolgen und kann z.B. in einem Begasungsbrutschrank bei 37°C und 5%C02 durchgeführt werden.Those skilled in the art know suitable experimental conditions for such stimulation, e.g. with regard to the concentration of the mitogens used, duration of the stimulation and other incubation conditions. The stimulation should take place in suitable vessels that allow sufficient gas exchange. The concentrations of the respective stimulation agents should be in the physiological range, e.g. for PHA lμg / ml to 20μg / ml, for PWM lμg / ml to 50μg / ml and for protein A lOμg / ml to 200μg / ml. The duration of the stimulation depends on the speed of expression of the molecule to be examined. For certain examinations, however, stimulation times of 2 to 24 hours may also be required; in the case of CD69, a stimulation period of 4 hours is optimal. The stimulation should take place under physiological conditions and can e.g. be carried out in a fumigation incubator at 37 ° C and 5% C02.
Der Fachmann kennt auch geeignete Oberflächenmarker, anhand derer sich eine mitogene Stimulation manifestiert, z.B. CD69, CD25, CD45RO, CD63 oder HLA-DR, wobei der Oberflächenmarker CD69 bevorzugt ist. Es kann für die erfindungsgemäßen Zwecke auch die Bestimmung einer Kombination von Oberflächenmarkern erfolgen oder die weitere Spezifizierung der anhand eines bestimmten Oberflächenmarkers, z.B. CD69, separierten Zellen hinsichtlich weiterer Subpopulationen, z.B. anhand von (z.B. CD4+- und/oder CD8+ -und/oder CD19+ und /oder CD56+) Subpopulationen. Der Stimulationsindex (Aktivierungsindex) ergibt sich aus dem Verhältnis der Anzahl der den oder die Oberflächenmarker tragenden Zellen vor und nach Stimulation. Ein Stimulationsindex, der mindestens das 10-fache, maximal das 100-fache der unsti- mulierten Kontrollprobe erreicht, stellt ein Anzeichen für eine Alzheimersche Erkrankung oder eines Frühstadiums oder eine Prädisposition für diese Erkrankung dar. Ein Stimulationsindex, der weniger als das 10-fache der unstimulierten Kontrollprobe beträgt deutet nicht auf Anzeichen für eine Alzheimersche Erkrankung oder ein Frühstadiums oder eine Prädisposition für diese Erkrankung hin. Die Bestimmung der Oberflächenmarker tragenden Zellen kann nach üblichen Verfahren erfolgen, z.B., Western-Blot, ELISA, RIA, FACS, LSC etc.The person skilled in the art also knows suitable surface markers on the basis of which a mitogenic stimulation is manifested, for example CD69, CD25, CD45RO, CD63 or HLA-DR, the surface marker CD69 being preferred. For the purposes of the invention, it is also possible to determine a combination of surface markers or to further specify the cells separated on the basis of a specific surface marker, for example CD69, with regard to further subpopulations, for example on the basis of (for example CD4 + and / or CD8 + and / or CD19 + and / or CD56 + ) subpopulations. The stimulation index (activation index) results from the ratio of the number of cells carrying the surface marker or markers before and after stimulation. A stimulation index that is at least 10 times and at most 100 times the unstimulated control sample is a sign of Alzheimer's disease or an early stage or a predisposition to this disease. A stimulation index that is less than 10 times The unstimulated control sample does not indicate any signs of Alzheimer's disease or an early stage or a predisposition to this disease. The cells carrying surface markers can be determined by conventional methods, for example Western blot, ELISA, RIA, FACS, LSC etc.
Vorzugsweise erfolgt zur Bestimmung der Oberflächenmarker tragenden Zelle deren Abtrennung von den keinen Oberflächenmarker oder andere Oberflächenmarker tragenden Zellen anhand charakteristischer Zellmerkmale.For the determination of the cell carrying surface markers, it is preferable to separate them from the cells bearing no surface markers or other surface markers on the basis of characteristic cell features.
In dem Diagnoseverfahren der vorliegenden Erfindung erfolgt die Separierung der Oberflächenmarker tragenden Zellen von den nicht Oberflächenmarker tragenden Zellen durch gegen (den) die gewünschten Oberflächenmarker gerichtete Antikörper. Dabei kann es sich bei den dafür geeigneten Antikörpern um monoklona- le, polyklonale oder synthetische Antikörper oder Fragmente davon handeln. In diesem Zusammenhang bedeutet der Begriff „Fragment" alle Teile des monoklonalen Antikörpers (z.B. Fab-, Fv- oder „single chain Fv"-Fragmente) , welche die gleiche Epi- topspezifität wie der vollständige Antikörper aufweisen. Die Herstellung solcher Fragmente ist dem Fachmann bekannt, viele gegen Oberflächenmarker gerichtete Antikörper sind auch im Handel erhältlich.In the diagnostic method of the present invention, the separation of the cells bearing surface markers from the cells not bearing surface markers is carried out by antibodies directed against the desired surface marker. The suitable antibodies can be monoclonal, polyclonal or synthetic antibodies or fragments thereof. In this context, the term “fragment” means all parts of the monoclonal antibody (e.g. Fab, Fv or “single chain Fv” fragments) which have the same epitope specificity as the complete antibody. The preparation of such fragments is known to the person skilled in the art, and many antibodies directed against surface markers are also commercially available.
In der am meisten bevorzugten Ausführungsform des erfindungsgemäßen Diagnoseverfahrens ist der (sind die) Oberflächenmar- ker-spezifischen Antikörper an magnetische Partikel, beispielsweise paramagnetische Perlen (z. B. erhältlich von DYNAL A.S, P.O.Box 158 Sk0yen, N-0212 Oslo, Norway) gebunden, was die Separation der Zellen mit den entsprechenden Oberflächenmarkern über immuno-magnetische Separation gemäß gängiger Verfahren erlaub .In the most preferred embodiment of the diagnostic method according to the invention, the surface margin (s) is Ker-specific antibodies are bound to magnetic particles, for example paramagnetic beads (for example available from DYNAL AS, POBox 158 Sk0yen, N-0212 Oslo, Norway), which makes the separation of the cells with the corresponding surface markers via immuno-magnetic separation according to the usual method Allow procedure.
Der Stimulationsindex kann dann dadurch bestimmt werden, dass die Menge der mittels des gewünschten Oberflächenmarkers separierten Zellen anhand ihres Nukleinsäuregehalts und/oder Proteingehalts mittels gängiger Verfahren bestimmt wird, z.B. nach Lyse der Zellen durch spektrophotometrische Bestimmung des Nukleinsäure- bzw. Proteingehalts oder nach Anfärbung der Nukleinsäure mittels spezifischer Farbstoffe, z.B. Ethidi- umbromid, Propidium odid, Acridinorange , DAPI etc über photometrische Quantifizierung. Unter Verwendung von Eichkurven kann aus dem Protein- und/oder Nukleinsäuregehalt der Probe die Zellzahl rechnerisch ermittelt werden.The stimulation index can then be determined by determining the amount of cells separated by means of the desired surface marker on the basis of their nucleic acid content and / or protein content by means of common methods, e.g. after lysis of the cells by spectrophotometric determination of the nucleic acid or protein content or after staining of the nucleic acid using specific dyes, e.g. Ethidium bromide, propidium odid, acridine orange, DAPI etc. via photometric quantification. Using calibration curves, the cell number can be calculated from the protein and / or nucleic acid content of the sample.
Die vorliegende Erfindung betrifft auch einen Kit, der zur Durchführung des erfindungsgemäßen Diagnoseverfahrens geeignet ist und wenigstens folgende Bestandteile enthält: (a) Eine Verbindung zur mitogenen Stimulation; (b) mindestens einen gegen einen nach mitogener Stimulation exprimierten Oberflächenmarker gerichteten Antikörper, vorzugsweise einen an ein magnetisches Partikel gebundenen Antikörper.The present invention also relates to a kit which is suitable for carrying out the diagnostic method according to the invention and contains at least the following components: (a) a compound for mitogenic stimulation; (b) at least one antibody directed against a surface marker expressed after mitogenic stimulation, preferably an antibody bound to a magnetic particle.
Vorzugsweise enthält der erfindungsgemäße Kit außerdem (a) mindestens ein Reaktionsgefäß; (b) eine koagulationshemmde Verbindung und/oder einen Puffer zur Zell-Lyse; (c) einen Puffer zur Fixierung der Zellen; (d) Substanzen die für die quantitative Ermittlung der DNA- bzw. Proteinkonzentration erforderlich sind, sowie vorgefertigte Lösungen zur Herstellung einer Eichkurve; (e) einen Magneten zum Separieren der an die Magnetpartikel gebundenen Zellen (enthalten sofern ein an ein magnetisches Partikel gebundener Antikörper eingesetzt wird) ; und (f) ein Reagenz zum Ablösen gebundener magnetischer Partikel (enthalten sofern ein an ein magnetisches Partikel gebundener Antikörper eingesetzt wird)The kit according to the invention preferably also contains (a) at least one reaction vessel; (b) an anticoagulant compound and / or a buffer for cell lysis; (c) a buffer to fix the cells; (d) substances which are required for the quantitative determination of the DNA or protein concentration, as well as ready-made solutions for producing a calibration curve; (e) a magnet for separating the cells bound to the magnetic particles (included if an antibody bound to a magnetic particle is used); and (f) a reagent for detaching bound magnetic particles (included if an antibody bound to a magnetic particle is used)
In einer bevorzugten Ausführungsform des erfindungsgemäßen Kits ist der Antikörper ein anti-CD69-Antikörper . Der Kit kann außerdem noch zusätzlich oder anstelle des anti-CD-69- Antikörpers einen anti-CD4- und/oder anti-CD8-Antikörper enthalten.In a preferred embodiment of the kit according to the invention, the antibody is an anti-CD69 antibody. The kit may also contain an anti-CD4 and / or anti-CD8 antibody in addition to or instead of the anti-CD-69 antibody.
Schließlich kann der erfindungsgemäße Kit gegebenenfalls in Kombination mit einem oder mehreren geeigneten weiteren Nachweismitteln ,z.B., fluoreszenzgekoppelten Primärantikörpern, sekundären Antikörpern, Nachweismitteln für Proteine und/oder Nukleinsäuren, z.B. einem interkalierenden Farbstoff etc., vorliegen.Finally, the kit according to the invention can optionally be combined with one or more suitable further detection means, e.g. fluorescence-coupled primary antibodies, secondary antibodies, detection means for proteins and / or nucleic acids, e.g. an intercalating dye, etc.
Beispiel Bestimmung des mitogenen Stimulationsindex anhand CD69 bei Patienten mit Alzheimerscher ErkrankungExample Determination of the mitogenic stimulation index using CD69 in patients with Alzheimer's disease
Bestimmungen bisher bekannter Merkmale der Alzheimerschen Erkrankung, die sich am lebenden Patienten durchführen lassen (Biomarker) , zeigen nur eine ungenügende Sensitivität und Spezifität oder sind aus Kostengründen oder Gründen des hohen Aufwandes der Testanordnung nicht für Untersuchungen mit hohen Fallzahlen geeignet. Mit klinischen Mitteln beträgt die dia- gnostische Sicherheit nur 80% bis 90% und bereitet insbesondere in Erkrankungsfrühphasen differential-diagnostische Schwierigkeiten. Die Erkennung von präklinischen Erkrankungsphasen ist aufgrund des Fehlens eines geeigneten Biomarkers derzeit nicht möglich.Determinations of previously known features of Alzheimer's disease that can be carried out on living patients (biomarkers) show only insufficient sensitivity and specificity or are not suitable for investigations with high numbers of cases for reasons of cost or the high complexity of the test arrangement. With clinical means, the dia- Gnostic certainty only 80% to 90% and causes differential diagnostic difficulties, especially in the early stages of the disease. The detection of preclinical disease phases is currently not possible due to the lack of a suitable biomarker.
Den neurodegenerativen Veränderungen liegen bei der Alzheimerschen Erkrankung gestörte Prozesse der intrazellulären Vermittlung trophischer und mitogener Signale zugrunde. Diese Störungen der intrazellulären Signaltransduktion sind nicht auf das Nervensystem beschränkt. Sie lassen sich in ähnlicher Weise auch an Hautzellen sowie an Lymphozyten des peripheren Blutes dieser Patienten finden. Aufgrund ihrer Erkrankungsspezifität besitzt diese Veränderung diagnostischen Wert und eignet sich als Biomarker.In Alzheimer's disease, the neurodegenerative changes are based on impaired processes of intracellular mediation of trophic and mitogenic signals. These disorders of intracellular signal transduction are not limited to the nervous system. They can also be found in a similar manner on skin cells and on lymphocytes in the peripheral blood of these patients. Because of its disease specificity, this change has diagnostic value and is suitable as a biomarker.
Im nachfolgenden Beispiel erfolgte die Ermittlung, ob die für die Alzheimersche Erkrankung typische Störung der intrazellulären Vermittlung trophischer und mitogener Signale vorliegt, durch immuno-magnetische Zellseparation CD69 präsentierender Lymphozyten vor und nach mitogener Stimulation.In the following example, it was determined whether the disturbance in intracellular mediation of trophic and mitogenic signals typical of Alzheimer's disease is present by lymphocytes presenting CD69 presenting immuno-magnetic cell separation before and after mitogenic stimulation.
Die Gewinnung des Blutes erfolgte durch Venenpunktion unter Verwendung eines Blutentnahmesystems der Firma SARSTEDT. Das Blut wird dabei während der Entnahme durch im Blutentnahmesys- tem integrierte Antikoagulantien, wie z.B. Natriumzitrat oder Natrium-Heparin stabilisiert. In dieser Form kann es 24 bis 48- Stunden bei Raumtemperatur aufbewahrt werden. Die Stimulationsexperimente wurden in gut zu belüftenden Reaktionsgefäßen, wie z.B. einer 24 well Suspension-culture-plate der Firma Greiner bio-one durchgeführt. Dafür wurden zu je 400μl stabilisiertem Vollblut die Mitogene Phytohaemagglutinin (PHA) , Protein A und Pokeweed-Mitogen (PWM) jeweils einzeln oder in unterschiedlichen Kombinationen eingesetzt. Die Endkonzentrationen der jeweiligen Mitogene lag im physiologischen Bereich und betrug in diesem Beispiel für PHA 12μg/ml, für Protein A 50μg/ml und für PWM 4μg/ml. Die Stimulation erfolgte unter physiologischen Bedingungen bei 37°C und einer C02- Konzentration von 5% in einem Begasungsbrutschrank für eine Dauer von 4 Stunden. Jeweils lOOμl des stimulierten Vollblutes wurden mit verschiedenen Antikörper-beschichteten Magnetpartikeln inkubiert. In diesem Beispiel wurden anti-CD4 sowie anti CD8 beschichtete Magnetpartikel der Firma DYNAL verwendet. Die entsprechenden Magnetpartikel wurden der jeweiligen Probe im Überschuß (lOμl Magnetpartikel-Suspension) zugesetzt, um eine vollständige Isolation der entsprechenden Lymphozyten- Subpopulation zu gewährleisten. Nach einer Inkubationszeit von 30 Minuten bei 4°C wurden die entsprechende Lymphozyten- Subpopulation magnetisch separiert und nach darauffolgenden Waschschritten in lOOμl definiertes Medium, in diesem Beispiel RPMI1640, versetzt mit 1% fötalem Kälberserum (FKS) , überführt. Das Ablösen der gebundenen Magnetpartikel erfolgte in diesem Beispiel unter Verwendung von jeweils lOμl DETACHaBEAD der Firma DYNAL. Nach einer Inkubationszeit von 45 Minuten bei Raumtemperatur wurden die abgelösten Magnetpartikel separiert und die Zellsuspension nach mehrmaligem Waschen in ein definiertes Medium, in diesem Beispiel RPMI1640 aufgenommen. Durch Zugabe eines spezifischen Lysepuffers wurden die Zellen aufgeschlossen, die DNA mit spezifischen DNA Farbstoffen, wie z.B. Ethidiumbromid, Propidiumiodid, Acridinorange oder DAPI markiert und diese im Anschluß photometrisch quantifiziert. Unter Verwendung der Proteinbestimmungsmethode nach Bradford wurde der Proteingehalt der Proben verglichen. Unter Verwendung von Eichkurven wurde aus dem DNA- und/oder Proteingehalt der Probe die Zellzahl rechnerisch ermittelt. Diese Vorgehensweise erlaubte einen direkten Rückschluß auf die Zellzahl. Die Berechnung des Quotienten aus der Zahl CD69 präsentierender Zellen vor und nach mitogener Stimulation (Stimulationsindex) gab Aufschluss über Veränderungen mitogener Stimulierbarkeit dieser Zellen. Ein Stimulationsindex, der mindestens das 10-fache, maximal das 100-fache der unstimulierten Kontrollprobe erreicht, ist ein Anzeichen für eine Alzheimersche Erkrankung oder ein Frühstadiums oder eine Prädisposition für diese Erkrankung. • Ein Stimulationsindex, der weniger als das 10-fache der unstimulierten Kontrollprobe beträgt, deutet nicht auf Anzeichen für eine Alzheimersche Erkrankung oder ein Frühstadiums oder eine Prädisposition für diese Erkrankung hin.The blood was obtained by venipuncture using a SARSTEDT blood collection system. The blood is stabilized during the withdrawal by anticoagulants integrated in the blood collection system, such as sodium citrate or sodium heparin. In this form it can be stored at room temperature for 24 to 48 hours. The stimulation experiments were carried out in well-ventilated reaction vessels, such as a 24 well suspension culture plate from Greiner bio-one. For this purpose, the mitogens phytohaemagglutinin (PHA), protein A and Pokeweed mitogen (PWM) were used individually or in different combinations for 400μl of stabilized whole blood. The final concentrations of the respective mitogens were in the physiological range and in this example was 12μg / ml for PHA, 50μg / ml for Protein A and 4μg / ml for PWM. The stimulation was carried out under physiological conditions at 37 ° C. and a CO 2 concentration of 5% in a fumigation incubator for a period of 4 hours. In each case 100 μl of the stimulated whole blood were incubated with various antibody-coated magnetic particles. In this example, anti-CD4 and anti-CD8 coated magnetic particles from DYNAL were used. The corresponding magnetic particles were added to the respective sample in excess (10 μl magnetic particle suspension) in order to ensure complete isolation of the corresponding lymphocyte subpopulation. After an incubation period of 30 minutes at 4 ° C., the corresponding lymphocyte subpopulation was magnetically separated and, after subsequent washing steps, transferred to 100 μl of defined medium, in this example RPMI1640, mixed with 1% fetal calf serum (FCS). In this example, the bound magnetic particles were detached using 10 μl DETACHaBEAD from DYNAL. After an incubation time of 45 minutes at room temperature, the detached magnetic particles were separated and the cell suspension was taken up in a defined medium, in this example RPMI1640, after washing several times. The cells were disrupted by adding a specific lysis buffer, the DNA was labeled with specific DNA dyes, such as, for example, ethidium bromide, propidium iodide, acridine orange or DAPI, and these were then quantified photometrically. The protein content of the samples was compared using the Bradford protein determination method. Using calibration curves, the cell number was calculated from the DNA and / or protein content of the sample. This procedure allowed a direct conclusion to be drawn about the cell number. The calculation of the quotient from the number of cells presenting CD69 before and after mitogenic stimulation (stimulation index) provided information about changes in mitogenic stimulability of these cells. A stimulation index that is at least 10 times and at most 100 times the unstimulated control sample is a sign of Alzheimer's disease or an early stage or a predisposition to this disease. • A stimulation index less than 10 times that of the unstimulated control sample does not indicate any signs of Alzheimer's disease or early stage or predisposition to this disease.
In einem weiteren Experiment erfolgte die Bestimmung des Proteingehaltes der Probe, sowie die Bestimmung des DNA-Gehaltes ohne Zugabe von DNA-färbenden Substanzen zur quantitativen Ermittlung der CD69-präsentierenden Zellen. In diesem Fall wurde die Absorption von DNA bzw. Protein von Licht einer bestimmten Wellenlänge (z.B. 260 nm bzw. 280 nm) gemessen. In a further experiment, the protein content of the sample was determined, and the DNA content was determined without the addition of DNA-staining substances for the quantitative determination of the CD69-presenting cells. In this case, the absorption of DNA or protein by light of a certain wavelength (e.g. 260 nm or 280 nm) was measured.

Claims

Patentansprüche claims
1. Verfahren zur Diagnose der Alzheimerschen Erkrankung oder eines Frühstadiums oder einer Prädisposition für diese Erkrankung anhand einer Probe von einem Patienten, wobei das Verfahren die folgenden Schritte umfasst: (a) mitogene Stimulation der peripher zugänglichen Zellen in der Probe; (b) quantitative Bestimmung der mitogen stimulierten Zellen innerhalb der Zellpopulation vor und nach Schritt (a) anhand von einem oder mehreren nach mitogener Stimulation exprimierten Oberflächenmarkern, wobei die Oberflächenmarker tragenden Zellen von den keinen Oberflächenmarker tragenden Zellen unter Verwendung von gegen die Oberflächen- marker gerichteten Antikörpern separiert werden; (c) Bestimmung des Stimulationsindex als Verhältnis der Anzahl der den oder die Oberflächenflächenmarker tragenden Zellen vor und nach Schritt (a) , wobei ein Stimulationsindex, der mindestens das 10-fache, maximal das 100-fache der unstimulierten Kontrollprobe erreicht, ein Anzeichen für eine Alzheimersche Erkrankung oder ein Frühstadiums oder eine Prädisposition für diese Erkrankung ist.1. A method for diagnosing Alzheimer's disease or an early stage or predisposition to this disease using a sample from a patient, the method comprising the steps of: (a) mitogenic stimulation of the peripherally accessible cells in the sample; (b) quantitative determination of the mitogenically stimulated cells within the cell population before and after step (a) on the basis of one or more surface markers expressed after mitogenic stimulation, the cells bearing the surface markers from the cells bearing no surface markers using cells which are directed against the surface markers Antibodies are separated; (c) Determination of the stimulation index as a ratio of the number of cells carrying the surface area marker (s) before and after step (a), wherein a stimulation index that reaches at least 10 times and at most 100 times the unstimulated control sample is an indication of a Alzheimer's disease or an early stage or predisposition to this disease.
2. Verfahren nach Anspruch 1, wobei die Probe eine Blutprobe ist und die Zellen Lymphozyten sind.2. The method of claim 1, wherein the sample is a blood sample and the cells are lymphocytes.
3. Verfahren nach Anspruch 1 oder 2, wobei der Oberflächenmarker CD69 ist.3. The method of claim 1 or 2, wherein the surface marker is CD69.
4. Verfahren nach Anspruch 3, wobei die CD69+-Zellen hinsichtlich CD4+- und/oder CD8+-Subpopulationen weiter spezifiziert werden. 4. The method of claim 3, wherein the CD69 + cells are further specified with respect to CD4 + and / or CD8 + subpopulations.
5. Verfahren nach einem der Ansprüche 1 bis 4, wobei vor Schritt (a) die Stabilisierung des Bluts durch eine oder mehrere koagulationshemmende Verbindungen erfolgt.5. The method according to any one of claims 1 to 4, wherein before step (a) the blood is stabilized by one or more anticoagulant compounds.
6. Verfahren nach einem der Ansprüche 1 bis 5, wobei die Stimulation der Zellen durch PHA, Protein A oder PWM erfolgt.6. The method according to any one of claims 1 to 5, wherein the stimulation of the cells is carried out by PHA, protein A or PWM.
7. Verfahren nach Anspruch 1, wobei die Antikörper in Schritt (b) an magnetische Partikel gebunden sind und die Separation über immuno-magnetische Separation erfolgt.7. The method according to claim 1, wherein the antibodies in step (b) are bound to magnetic particles and the separation takes place via immuno-magnetic separation.
8. Verfahren nach einem der Ansprüche 1 bis 7, wobei der Stimulationsindex über die Bestimmung des Proteingehalts und/oder Nukleinsäuregehalts der Oberflächenmarker tragenden Zellen vor und nach Schritt (a) bestimmt wird.8. The method according to any one of claims 1 to 7, wherein the stimulation index is determined via the determination of the protein content and / or nucleic acid content of the cells carrying surface markers before and after step (a).
9. Kit zur Diagnose der Alzheimerschen Erkrankung oder eines Fruhstadiums oder einer Prädisposition für diese Erkrankung, wobei der Kit folgende Bestandteile enthält: (a) Eine Verbindung zur mitogenen Stimulation; und (b) mindestens einen gegen einen nach mitogener Stimulation exprimierten Oberflächenmarker gerichteten Antikörper.9. A kit for diagnosing Alzheimer's disease or an early stage or predisposition to that disease, the kit comprising: (a) a compound for mitogenic stimulation; and (b) at least one antibody directed against a surface marker expressed after mitogenic stimulation.
10. Kit nach Anspruch 9, der außerdem enthält: (c) eine koagulationshemmde Verbindung; und/oder (d) einen Puffer zur Zell-Lyse.10. The kit of claim 9, further comprising: (c) an anticoagulant compound; and / or (d) a buffer for cell lysis.
11. Kit nach Anspruch 9 oder 10, wobei der Antikörper ein an ein magnetische Partikel gebundener Antikörper ist.11. The kit of claim 9 or 10, wherein the antibody is an antibody bound to a magnetic particle.
12. Kit nach einem der Ansprüche 9 bis 11, wobei der Antikörper ein anti-CD69-Antikörper ist.12. Kit according to any one of claims 9 to 11, wherein the antibody is an anti-CD69 antibody.
13. Kit nach einem der Ansprüche 9 bis 12, der außerdem einen anti-CD4- und/oder anti-CD8-Antikörper enthält. 13. Kit according to one of claims 9 to 12, which also contains an anti-CD4 and / or anti-CD8 antibody.
EP04765688A 2003-10-22 2004-09-29 Quick test for the diagnosis of alzheimer' disease Ceased EP1685408A1 (en)

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GB201212084D0 (en) * 2012-07-06 2012-08-22 Randox Lab Ltd Tropomyosin isoforms related to alzheimers disease and mild cognitive impairment
WO2014205406A1 (en) * 2013-06-20 2014-12-24 Amarantus Bioscience Holdings, Inc. Methods, systems, and composition related to neural disorders
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US20220260595A1 (en) * 2019-07-10 2022-08-18 Todos Medical Ltd. A biomarker for alzheimer's disease using blood samples from clinically diagnosed alzheimer's disease subjects
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